Healthcare Provider Details

I. General information

NPI: 1326533910
Provider Name (Legal Business Name): MRS. ANGELINA MASTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 JACKSONVILLE RD
BAGDAD KY
40003-7095
US

IV. Provider business mailing address

6540 FRANKFORT RD
SHELBYVILLE KY
40065-9561
US

V. Phone/Fax

Practice location:
  • Phone: 502-529-2278
  • Fax:
Mailing address:
  • Phone: 502-220-9297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number302228
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: