Provider Demographics
NPI:1699051508
Name:CLEGG, ANGELA SIMA (NP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:SIMA
Last Name:CLEGG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 JACKSON AVE W
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5403
Mailing Address - Country:US
Mailing Address - Phone:662-513-6682
Mailing Address - Fax:662-513-6684
Practice Address - Street 1:942 COMMONWEALTH BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-9762
Practice Address - Country:US
Practice Address - Phone:866-870-5570
Practice Address - Fax:662-620-0095
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR869368363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily