Provider Demographics
NPI:1013606730
Name:OWINGS MOORE, ANGELA JEAN
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:JEAN
Last Name:OWINGS MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-2238
Mailing Address - Country:US
Mailing Address - Phone:580-271-7055
Mailing Address - Fax:
Practice Address - Street 1:301 N HIGH ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-2238
Practice Address - Country:US
Practice Address - Phone:580-271-7055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty