Healthcare Provider Details

I. General information

NPI: 1568113116
Provider Name (Legal Business Name): ANGELA RENEE HANKS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA RENEE POOLE

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 RICHMOND RD
LEXINGTON KY
40509-1599
US

IV. Provider business mailing address

240 MADISON VIEW RD
BEREA KY
40403-8471
US

V. Phone/Fax

Practice location:
  • Phone: 859-269-2273
  • Fax:
Mailing address:
  • Phone: 859-475-2344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number3017281
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: