Provider Demographics
NPI:1962159426
Name:POE, ANGELA KAY (RN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAY
Last Name:POE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8731 BLUE MARLIN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-7987
Mailing Address - Country:US
Mailing Address - Phone:317-414-4173
Mailing Address - Fax:
Practice Address - Street 1:8677 IMPACT CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1424
Practice Address - Country:US
Practice Address - Phone:317-895-7173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28102034A163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN8677OtherCONCENTRA