Provider Demographics
NPI:1205988235
Name:PARSONS-WOODS, ANGELA L (PA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:PARSONS-WOODS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 NEWCOMB AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-2728
Mailing Address - Country:US
Mailing Address - Phone:606-256-5176
Mailing Address - Fax:606-256-4401
Practice Address - Street 1:140 NEWCOMB AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-2728
Practice Address - Country:US
Practice Address - Phone:606-256-5176
Practice Address - Fax:606-256-4401
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA861363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95005252Medicaid
000000359662OtherANTHEM BC BS
KY95005252Medicaid
KY0231009Medicare ID - Type Unspecified