Provider Demographics
NPI:1841774544
Name:THAYER, ANGELA JEANETTE
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:JEANETTE
Last Name:THAYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:JEANETTE
Other - Last Name:CAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-NPC
Mailing Address - Street 1:3001 QUAIL SPRINGS PKWY FL 5
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-2640
Mailing Address - Country:US
Mailing Address - Phone:405-573-5400
Mailing Address - Fax:405-951-8849
Practice Address - Street 1:1431 24TH AVE NW
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6386
Practice Address - Country:US
Practice Address - Phone:405-573-5400
Practice Address - Fax:405-951-8849
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK83626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily