Provider Demographics
NPI:1558380824
Name:SMOTHERS, ANGEL (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:
Last Name:SMOTHERS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 326
Mailing Address - Street 2:
Mailing Address - City:MC COMAS
Mailing Address - State:WV
Mailing Address - Zip Code:24747-9602
Mailing Address - Country:US
Mailing Address - Phone:304-589-6327
Mailing Address - Fax:
Practice Address - Street 1:10001 SIMMONS RIVER RD
Practice Address - Street 2:
Practice Address - City:MONTCALM
Practice Address - State:WV
Practice Address - Zip Code:24737
Practice Address - Country:US
Practice Address - Phone:304-589-3251
Practice Address - Fax:304-589-6363
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV57599207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine