Angela Ford

Individual provider Active NPI Community Health Worker · Sour Lake, TX

NPI 1063825834 · NPPES record last updated Jun 9, 2014

Key facts

NPI
1063825834
Entity type
Individual (NPI type 1)
Primary specialty
Community Health Worker 172V00000X
License
2048442 (TX)
Practice address
311 Pinehurst Dr
Sour Lake, TX 77659-9250
Phone
(903) 245-6892
NPI assigned
Jun 9, 2014
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
2048442TXMDCommunity Health Worker

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Worker 172V00000X 2048442 TX Yes

Addresses

Primary practice location

311 Pinehurst Dr
Sour Lake, TX 77659-9250

Mailing address

311 Pinehurst Dr
Sour Lake, TX 77659-9250

Other providers in Sour Lake, TX

All providers in Sour Lake, TX · Community Health Worker in Texas

Sources for this page

Verify at the official NPI Registry.