Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 3012229 | KY |
NPI | 1003251612 |
---|---|
Provider Name | Mrs. Angela Jo Cain |
First Address | West Somerset, KY 42564-3044 |
Second Address | Somerset, KY 42501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2013 |
Last Update Date | 07/09/2021 |