Basic Information
Provider Information | |||||||||
NPI: | 1205806536 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CURRY | ||||||||
FirstName: | ANGELA | ||||||||
MiddleName: | K | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1523 | ||||||||
Address2: |   | ||||||||
City: | FAYETTEVILLE | ||||||||
State: | AR | ||||||||
PostalCode: | 727021523 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4795716038 | ||||||||
FaxNumber: | 4795820222 | ||||||||
Practice Location | |||||||||
Address1: | 3302 N NORTHHILLS BLVD | ||||||||
Address2: |   | ||||||||
City: | FAYETTEVILLE | ||||||||
State: | AR | ||||||||
PostalCode: | 727034008 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4795823366 | ||||||||
FaxNumber: | 4795716572 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/26/2006 | ||||||||
LastUpdateDate: | 12/15/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/15/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | E3155 | AR | N |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   | 207VG0400X | E-3155 | AR | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
ID | Type | State | Issuer | Description | 160055510 | 01 | AR | MEDICARE RAILROAD CARRIER | OTHER | 7731636 | 01 |   | CIGNA | OTHER | 11091000040 | 01 | AR | QUALCHOICE | OTHER | 5M063 | 01 | AR | BLUE CROSS | OTHER | 145847001 | 05 | AR |   | MEDICAID | 770240801 | 01 | AR | EDS BREASTCARE | OTHER | AS0140025 | 01 |   | HUMANA TRICARE | OTHER |