Provider Demographics
NPI:1326910670
Name:MCCORMICK, ANGEL (APRN)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 NILES DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3026
Mailing Address - Country:US
Mailing Address - Phone:859-361-6420
Mailing Address - Fax:
Practice Address - Street 1:601 DOE RUN DR STE 5
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9097
Practice Address - Country:US
Practice Address - Phone:859-361-6420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4046648363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health