Provider Demographics
NPI:1558696047
Name:STURGEON, ANGELA KAYE (APRN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAYE
Last Name:STURGEON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-2203
Mailing Address - Country:US
Mailing Address - Phone:859-655-6100
Mailing Address - Fax:859-721-3918
Practice Address - Street 1:200 RICE ST
Practice Address - Street 2:
Practice Address - City:WILMORE
Practice Address - State:KY
Practice Address - Zip Code:40390-1359
Practice Address - Country:US
Practice Address - Phone:859-881-4288
Practice Address - Fax:859-881-4388
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006227363L00000X, 363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100106100Medicaid
KY6227POtherNURSE PRACTITIONER
KYK086580Medicare PIN
KY0960405Medicare PIN
KY6227POtherNURSE PRACTITIONER
KY7100106100Medicaid