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General NPI Number Information
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NPI Number | 1699051508
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Entity Type | Individual
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Provider Name | ANGELA SIMA CLEGG NP
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Gender | Female
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 942 COMMONWEALTH BLVD
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City | TUPELO
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State | MS
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Zip | 38804-9762
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Country | US
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Telephone | 866-870-5570
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Fax | 662-620-0095
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Provider Business Mailing Address
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Address Line | 2530 JACKSON AVE W
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City | OXFORD
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State | MS
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Zip | 38655-5403
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Country | US
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Telephone | 662-513-6682
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Fax | 662-513-6684
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R869368
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License Number State | MS
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