Provider Demographics
NPI:1841442183
Name:KEEL, ANGELA ROBERSON (LPTA)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ROBERSON
Last Name:KEEL
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 JACK ROBERSON RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-8602
Mailing Address - Country:US
Mailing Address - Phone:252-792-8534
Mailing Address - Fax:
Practice Address - Street 1:119 GATLIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2560
Practice Address - Country:US
Practice Address - Phone:252-792-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC815172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker