Healthcare Provider Details

I. General information

NPI: 1528212164
Provider Name (Legal Business Name): ANGELA MARIE HOUSEWORTH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 2ND AVE E
ONEONTA AL
35121-2506
US

IV. Provider business mailing address

1697 MONMOUTH ST SUITE A
NEWPORT KY
41071-2664
US

V. Phone/Fax

Practice location:
  • Phone: 205-395-5014
  • Fax:
Mailing address:
  • Phone: 859-292-0123
  • Fax: 859-292-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5824P
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3-000278
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: