Healthcare Provider Details

I. General information

NPI: 1174711295
Provider Name (Legal Business Name): ANGELA WOOTEN CASE MANAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 HAPPY VALLEY RD
GLASGOW KY
42141-1561
US

IV. Provider business mailing address

209 MARION DR
GLASGOW KY
42141-3028
US

V. Phone/Fax

Practice location:
  • Phone: 270-901-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: