Provider Demographics
NPI:1548672413
Name:PUGSLEY, ANGELA (APRN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PUGSLEY
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:PO BOX 1960
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1960
Mailing Address - Country:US
Mailing Address - Phone:870-936-8000
Mailing Address - Fax:870-934-3653
Practice Address - Street 1:900 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-9239
Practice Address - Country:US
Practice Address - Phone:870-936-8000
Practice Address - Fax:870-934-3653
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARS002283364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARS002283OtherARKANSAS LICENSE
AR397152YJNYMedicare UPIN