Provider Demographics
NPI:1538434295
Name:MARTIN, ANGELA KAY (APN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KAY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 W. COLLIN RAYE DR.
Mailing Address - Street 2:SUITE A
Mailing Address - City:DEQUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832
Mailing Address - Country:US
Mailing Address - Phone:870-642-2273
Mailing Address - Fax:870-642-2162
Practice Address - Street 1:3397 N CAMELLIA
Practice Address - Street 2:
Practice Address - City:LOCKESBURG
Practice Address - State:AR
Practice Address - Zip Code:71846-9608
Practice Address - Country:US
Practice Address - Phone:870-829-5190
Practice Address - Fax:870-289-6840
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03639363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily