Healthcare Provider Details

I. General information

NPI: 1730284399
Provider Name (Legal Business Name): ANGELA PURDY IVEY CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 SAFRIT DR
BEAUFORT NC
28516-9017
US

IV. Provider business mailing address

1504 OTTER CT
MOREHEAD CITY NC
28557-4718
US

V. Phone/Fax

Practice location:
  • Phone: 252-728-4583
  • Fax:
Mailing address:
  • Phone: 252-375-7264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7435
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: