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NPI Code Detail

MEDICARE: ANGELA K WOOTON N.P.

MEDICARE: ANGELA K WOOTON N.P.
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
1363L00000XNurse Practitioner71001340AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000315362OTHERINBCBS PIN

General Provider Information

NPI Number : 1215939418
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA K WOOTON N.P.
Provider Business Mailing Address
First Line : PO BOX 3407
Second Line :
City : EVANSVILLE
State : IN
Zip : 47733-3407
Country : US
Telephone Number : 812-450-6815
Fax Number : 812-450-6822
Provider Business Practice Location Address
First Line : 8600 UNIVERSITY BLVD
Second Line : RM HP0091
City : EVANSVILLE
State : IN
Zip : 47712-3534
Country : US
Telephone Number : 812-465-1250
Fax Number : 812-465-7170
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 07/08/2007

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Directions to “ ANGELA K WOOTON N.P.” Practice Location

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