MEDICARE: ANGELA KAY MCNUTT NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1-50513	AL

General Provider Information

NPI Number	:	1437789609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA KAY MCNUTT NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	PO BOX 169
Second Line	:
City	:	PARRISH
State	:	AL
Zip	:	35580-0169
Country	:	US
Telephone Number	:	205-686-5113
Fax Number	:	205-265-2994

Provider Business Practice Location Address
First Line	:	25734 HIGHWAY 195
Second Line	:
City	:	DOUBLE SPRINGS
State	:	AL
Zip	:	35553-2308
Country	:	US
Telephone Number	:	205-686-5113
Fax Number	:	205-413-4968

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2020
Last Update Date	:	04/08/2025

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