Provider Demographics
NPI:1659438968
Name:MOULTON, ANGELA KAY (MSN, CPNP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:KAY
Last Name:MOULTON
Suffix:
Gender:F
Credentials:MSN, CPNP
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:KAY MOULTON
Other - Last Name:TRAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-543-3276
Mailing Address - Fax:330-543-8489
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308
Practice Address - Country:US
Practice Address - Phone:330-543-3276
Practice Address - Fax:330-543-8489
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.08425-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner