Provider Demographics
NPI:1821163627
Name:MCCULLEY, ANGELA MARY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARY
Last Name:MCCULLEY
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1335 CROWN BRK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-2485
Mailing Address - Country:US
Mailing Address - Phone:210-887-8593
Mailing Address - Fax:
Practice Address - Street 1:921 LAKEVIEW BLVD
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-4135
Practice Address - Country:US
Practice Address - Phone:830-620-7744
Practice Address - Fax:830-625-0353
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA 04212363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ38660Medicare UPIN