Provider Demographics
NPI:1538913561
Name:TYREE, ANGELA KAYE (RN, BSN, CPN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KAYE
Last Name:TYREE
Suffix:
Gender:F
Credentials:RN, BSN, CPN
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:KAYE
Other - Last Name:TYREE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, BSN, CPN
Mailing Address - Street 1:109 FRENCH LN
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:VA
Mailing Address - Zip Code:24521-4763
Mailing Address - Country:US
Mailing Address - Phone:434-713-0861
Mailing Address - Fax:
Practice Address - Street 1:2137 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6806
Practice Address - Country:US
Practice Address - Phone:434-404-7200
Practice Address - Fax:434-385-8616
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001265073163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Single Specialty