Healthcare Provider Details

I. General information

NPI: 1356289813
Provider Name (Legal Business Name): ANGELA LEE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 CEDAR POINT BLVD STE F
CEDAR POINT NC
28584-1030
US

IV. Provider business mailing address

1165 CEDAR POINT BLVD STE F
CEDAR POINT NC
28584-1030
US

V. Phone/Fax

Practice location:
  • Phone: 252-364-4690
  • Fax:
Mailing address:
  • Phone: 252-364-4690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5024243
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: