Healthcare Provider Details

I. General information

NPI: 1154801454
Provider Name (Legal Business Name): ANGELA KAYE LLEWELLYN NP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA KAYE RICHARDSON RN

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 BURLEYSON RD STE 104
DALTON GA
30720-3094
US

IV. Provider business mailing address

1109 BURLEYSON RD STE 104
DALTON GA
30720-3094
US

V. Phone/Fax

Practice location:
  • Phone: 706-281-8490
  • Fax: 706-529-8487
Mailing address:
  • Phone: 706-281-8490
  • Fax: 706-529-8487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP004402
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24474
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPN24474
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number24474
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberGAA-NP004402
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: