Healthcare Provider Details

I. General information

NPI: 1720898190
Provider Name (Legal Business Name): ANGELA GWYN MCCREARY IPHM, CHHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 GREENFIELD LN
ESTILL SPRINGS TN
37330-3410
US

IV. Provider business mailing address

113 GREENFIELD LN
ESTILL SPRINGS TN
37330-3410
US

V. Phone/Fax

Practice location:
  • Phone: 931-247-6420
  • Fax:
Mailing address:
  • Phone: 931-247-6420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License NumberIPHMNM16944
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: