Healthcare Provider Details

I. General information

NPI: 1538029517
Provider Name (Legal Business Name): ANGELA PATTERSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 CARMELLO AVE
PRINCETON WV
24740-4929
US

IV. Provider business mailing address

172 CARMELLO AVE
PRINCETON WV
24740-4929
US

V. Phone/Fax

Practice location:
  • Phone: 276-280-8644
  • Fax:
Mailing address:
  • Phone: 276-280-8644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: