Provider Demographics
NPI:1912771882
Name:BAGLEY, ANGEL DAWN (RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:DAWN
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22675 HIGHWAY M
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:MO
Mailing Address - Zip Code:64661-7907
Mailing Address - Country:US
Mailing Address - Phone:660-953-1529
Mailing Address - Fax:
Practice Address - Street 1:630 W 3RD ST
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MO
Practice Address - Zip Code:63556-1076
Practice Address - Country:US
Practice Address - Phone:660-265-4212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011008135163W00000X
MO2023045094363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse