MEDICARE: ANGELI B SWALLOWS AGPCNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	APN0000017640	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4357579	OTHER	TN	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043652738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELI B SWALLOWS AGPCNP-BC

Provider Business Mailing Address
First Line	:	127 N OAK AVE
Second Line	:	SUITE D
City	:	COOKEVILLE
State	:	TN
Zip	:	38501-2435
Country	:	US
Telephone Number	:	931-783-5857
Fax Number	:	931-526-6760

Provider Business Practice Location Address
First Line	:	228 W 4TH ST
Second Line	:	SUITE 301
City	:	COOKEVILLE
State	:	TN
Zip	:	38501-2488
Country	:	US
Telephone Number	:	931-783-4269
Fax Number	:	931-372-0401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2013
Last Update Date	:	04/26/2018

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