Provider Demographics
NPI:1760429039
Name:STYLES, ANGELA ROSE (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ROSE
Last Name:STYLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-3739
Mailing Address - Country:US
Mailing Address - Phone:479-754-4333
Mailing Address - Fax:479-754-1099
Practice Address - Street 1:201 S ROGERS ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-3739
Practice Address - Country:US
Practice Address - Phone:479-754-4333
Practice Address - Fax:479-754-1099
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8311174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131345001Medicaid
AR5J776Medicare ID - Type Unspecified
ARG05674Medicare UPIN