Provider Demographics
NPI:1568108025
Name:MANGUM, ANGELA NICOLE (MSN, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:NICOLE
Last Name:MANGUM
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6843 RIVALDO DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-8250
Mailing Address - Country:US
Mailing Address - Phone:940-257-1042
Mailing Address - Fax:775-799-2043
Practice Address - Street 1:3080 VISTA BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-6713
Practice Address - Country:US
Practice Address - Phone:940-257-1042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV845448363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health