Fagan, Angela

Fagan, Angela is an individual health care provider with primary practice located at 2500 N State St , Jackson MS 39216-4500. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Acute Care, which is considered as her primary health care specialty. Fagan, Angela can be contacted via phone (601) 984-6426.

Contact Information

Primary practice address
2500 N State St Jackson MS 39216-4500
Phone: (601) 984-6426
Fax: (601) 984-5503
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X R858439 Mississippi

Profile Details

NPI number 1073944971
LBN Legal business name Fagan, Angela
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 3rd, 2013
Last updated Nov 7th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073944971 NPPES
Mississippi MEDICAID 04888572

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