Basic Information
| Provider Information | |||||||||
| NPI: | 1659672905 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANGUS | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, MSN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 122 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | CLAY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 250437046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045877301 | ||||||||
| FaxNumber: | 3045872464 | ||||||||
| Practice Location | |||||||||
| Address1: | 122 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | CLAY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 250437046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045877301 | ||||||||
| FaxNumber: | 3045872464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2010 | ||||||||
| LastUpdateDate: | 08/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 68732 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1659762905 | 05 | WV | MEDICAID |