Provider Demographics
NPI:1720898190
Name:MCCREARY, ANGELA GWYN (IPHM, CHHP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:GWYN
Last Name:MCCREARY
Suffix:
Gender:F
Credentials:IPHM, CHHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 GREENFIELD LN
Mailing Address - Street 2:
Mailing Address - City:ESTILL SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37330-3410
Mailing Address - Country:US
Mailing Address - Phone:931-247-6420
Mailing Address - Fax:
Practice Address - Street 1:113 GREENFIELD LN
Practice Address - Street 2:
Practice Address - City:ESTILL SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37330-3410
Practice Address - Country:US
Practice Address - Phone:931-247-6420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNIPHMNM16944374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Multi-Specialty