Basic Information
| Provider Information | |||||||||
| NPI: | 1962796466 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'QUINN | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 E LIBERTY ST | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063850681 | ||||||||
| FaxNumber: | 6063307825 | ||||||||
| Practice Location | |||||||||
| Address1: | 12579 MAIN STREET | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MARTIN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062850681 | ||||||||
| FaxNumber: | 6062856769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2011 | ||||||||
| LastUpdateDate: | 02/03/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 03719 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.