Provider Demographics
NPI:1982410338
Name:BADDLEY, ANGEL (FNP)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:BADDLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1296 E OLD HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:EUPORA
Mailing Address - State:MS
Mailing Address - Zip Code:39744-2847
Mailing Address - Country:US
Mailing Address - Phone:662-769-0497
Mailing Address - Fax:
Practice Address - Street 1:521 S MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-3337
Practice Address - Country:US
Practice Address - Phone:662-338-4826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily