Provider Demographics
NPI:1598219214
Name:WILLIAMS-KENT, ANGEL MARIE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:MARIE
Last Name:WILLIAMS-KENT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:ANGEL
Other - Middle Name:M
Other - Last Name:WILLIAMS-KENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:3101 AMERICAN LEGION RD STE 12
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5655
Mailing Address - Country:US
Mailing Address - Phone:757-469-1452
Mailing Address - Fax:757-956-5073
Practice Address - Street 1:3101 AMERICAN LEGION RD STE 12
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5655
Practice Address - Country:US
Practice Address - Phone:757-469-1452
Practice Address - Fax:757-956-5073
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2022-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173850363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1598219214OtherVIRGINIA PREMIER HEALTH PLAN
NC1598219214Medicaid
VA1598219214OtherOPTIMA HEALTH
VA1598219214OtherTRICARE/CHAMPUS
VA1598219214Medicaid
VA1598219214OtherUSA MANAGED CARE
VA1598219214OtherCORVEL
VAVVM987AM946OtherMEDICARE PIN
VA1598219214OtherHUMANA
VA1598219214OtherMULTIPLAN