Provider Demographics
NPI:1679574420
Name:THOMPSON, ANGELA (NP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:30 MEDICAL PARK STE 232
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6412
Mailing Address - Country:US
Mailing Address - Phone:304-234-9560
Mailing Address - Fax:304-242-4840
Practice Address - Street 1:30 MEDICAL PARK STE 232
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6412
Practice Address - Country:US
Practice Address - Phone:304-234-9560
Practice Address - Fax:304-242-4840
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV036484363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9600155000Medicaid
WVNP74832Medicare ID - Type Unspecified
WV9600155000Medicaid