Healthcare Provider Details

I. General information

NPI: 1013480979
Provider Name (Legal Business Name): ANGELA L LYBARGER APMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 S HIGHWAY 65 BLDG A
MARSHALL MO
65340-3702
US

IV. Provider business mailing address

2305 S HIGHWAY 65 BLDG A
MARSHALL MO
65340-3702
US

V. Phone/Fax

Practice location:
  • Phone: 660-886-7800
  • Fax: 660-831-3306
Mailing address:
  • Phone: 660-886-7800
  • Fax: 660-831-3306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2018044829
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: