Healthcare Provider Details

I. General information

NPI: 1558380824
Provider Name (Legal Business Name): ANGEL SMOTHERS CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 SIMMONS RIVER RD
MONTCALM WV
24737
US

IV. Provider business mailing address

RR 2 BOX 326
MC COMAS WV
24747-9602
US

V. Phone/Fax

Practice location:
  • Phone: 304-589-3251
  • Fax: 304-589-6363
Mailing address:
  • Phone: 304-589-6327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number57599
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: