Provider Demographics
NPI:1881099471
Name:ADAMS, ANGELA MARIE (MSN; FNP-BC)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MSN; FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 E GANNON DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2611
Mailing Address - Country:US
Mailing Address - Phone:636-282-0380
Mailing Address - Fax:877-592-0806
Practice Address - Street 1:1153 E GANNON DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2611
Practice Address - Country:US
Practice Address - Phone:636-282-0380
Practice Address - Fax:877-592-0806
Is Sole Proprietor?:No
Enumeration Date:2014-10-26
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007021521163W00000X
MO2014035637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2014035637OtherLICENSE