Provider Demographics
NPI:1619962040
Name:COMPTON, ANGELA C (MSN, RNC, CS-FNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:COMPTON
Suffix:
Gender:M
Credentials:MSN, RNC, CS-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1141 BROADRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-9464
Mailing Address - Country:US
Mailing Address - Phone:573-243-1079
Mailing Address - Fax:
Practice Address - Street 1:150 S MOUNT AUBURN RD
Practice Address - Street 2:SUITE 418
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4910
Practice Address - Country:US
Practice Address - Phone:573-332-6000
Practice Address - Fax:573-332-6125
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO134858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S88128Medicare UPIN