Healthcare Provider Details

I. General information

NPI: 1710669072
Provider Name (Legal Business Name): ANGEL E OPARA PHMNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W MAIN ST STE 512
FRANKFORT KY
40601-1840
US

IV. Provider business mailing address

8206 HIGHVIEW CT
CRESTWOOD KY
40014-8105
US

V. Phone/Fax

Practice location:
  • Phone: 574-546-1900
  • Fax: 574-546-1999
Mailing address:
  • Phone: 502-262-2887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4007287
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: