Provider Demographics
NPI:1962796466
Name:O'QUINN, ANGELA M (DO)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:O'QUINN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:606-385-0681
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:12579 MAIN STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649
Practice Address - Country:US
Practice Address - Phone:606-285-0681
Practice Address - Fax:606-285-6769
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03719207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine