Provider Demographics
NPI:1992291520
Name:BYNUM, ANGEL (NP)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:BYNUM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:
Other - Last Name:VANTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 9178
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-9178
Mailing Address - Country:US
Mailing Address - Phone:855-498-6767
Mailing Address - Fax:479-968-1673
Practice Address - Street 1:200 RIVER MARKET AVE STE 72201
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-1752
Practice Address - Country:US
Practice Address - Phone:501-492-0099
Practice Address - Fax:479-968-1673
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily