Provider Demographics
NPI:1790065068
Name:PIKE, ANGELA DAWN (DNP, FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:PIKE
Suffix:
Gender:F
Credentials:DNP, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 WHITSON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-7721
Mailing Address - Country:US
Mailing Address - Phone:816-273-9105
Mailing Address - Fax:816-294-0660
Practice Address - Street 1:412 N VINE
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-2842
Practice Address - Country:US
Practice Address - Phone:870-234-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011027232363LF0000X, 363LP0808X
KS53-77463-092363LP0808X
AR218276363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00991383OtherRR MEDICARE
MO1790065068Medicaid
KS200738960AMedicaid
MO701000195Medicare PIN