MEDICARE: MRS. ANGELINA MASTERS

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	101YP2500X	Professional Counselor	302228	KY
2	171M00000X	Case Manager/Care Coordinator		KY

General Provider Information

NPI Number	:	1326533910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELINA MASTERS

Provider Business Mailing Address
First Line	:	6540 FRANKFORT RD
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-9561
Country	:	US
Telephone Number	:	502-220-9297
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 JACKSONVILLE RD
Second Line	:
City	:	BAGDAD
State	:	KY
Zip	:	40003-7095
Country	:	US
Telephone Number	:	502-529-2278
Fax Number	:

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

Provider Enumeration Date	:	06/26/2018
Last Update Date	:	12/11/2025

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