Provider Demographics
NPI:1649773946
Name:GADDIS, ANGELA (APN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GADDIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:PARISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:9751 N 1710TH ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:IL
Mailing Address - Zip Code:62451-2632
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1418 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-2638
Practice Address - Country:US
Practice Address - Phone:317-613-1006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017328363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner