Healthcare Provider Details

I. General information

NPI: 1174295083
Provider Name (Legal Business Name): ANGELA LYKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 BAYOU ST
VINCENNES IN
47591-1034
US

IV. Provider business mailing address

1160 E SAINT CLAIR ST
VINCENNES IN
47591-4853
US

V. Phone/Fax

Practice location:
  • Phone: 812-886-6800
  • Fax: 812-886-6809
Mailing address:
  • Phone: 812-885-3325
  • Fax: 812-885-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number28137849A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: