Provider Demographics
NPI:1285259937
Name:MCCULLY, ANGELLA KALYN (DNP-FNP, ARNP-C, NLC)
Entity type:Individual
Prefix:DR
First Name:ANGELLA
Middle Name:KALYN
Last Name:MCCULLY
Suffix:
Gender:F
Credentials:DNP-FNP, ARNP-C, NLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3329
Mailing Address - Country:US
Mailing Address - Phone:503-325-4321
Mailing Address - Fax:
Practice Address - Street 1:1639 SE ENSIGN LN STE B103
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-7308
Practice Address - Country:US
Practice Address - Phone:503-338-4500
Practice Address - Fax:503-338-4501
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61076583363LF0000X
OR202103441NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily