Provider Demographics
NPI:1528434222
Name:KING, ANGELA L (FNP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:L
Other - Last Name:SUMPTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4731 BARBERRY CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-9329
Mailing Address - Country:US
Mailing Address - Phone:217-791-2003
Mailing Address - Fax:
Practice Address - Street 1:2905 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4274
Practice Address - Country:US
Practice Address - Phone:217-877-9117
Practice Address - Fax:217-877-3081
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily