Healthcare Provider Details

I. General information

NPI: 1326556184
Provider Name (Legal Business Name): ANGELA EALY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11273 HIGHWAY 61 N
ROBINSONVILLE MS
38664-9705
US

IV. Provider business mailing address

2737 BROWNING AVE
MEMPHIS TN
38114-4903
US

V. Phone/Fax

Practice location:
  • Phone: 662-363-3224
  • Fax: 662-363-3234
Mailing address:
  • Phone: 256-648-6960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23417
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number906482
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: