Individual provider Active NPI

Angela D. Gilliland, CNP

  • Nurse Practitioner
  • Waverly, OH
National Provider Identifier
1235388968
Registry record updated Dec 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APRN.CNP.14669 Issued in OH
Practice address
835 W Emmitt Ave
Waverly, OH 45690-1190
Phone
(740) 947-7662
Fax
(740) 941-0099
NPI assigned
Sep 18, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 21, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X APRN.CNP.14669 OH Primary

Addresses

Primary practice location

835 W Emmitt Ave
Waverly, OH 45690-1190

Mailing address

1735 27TH St Ste B06
Portsmouth, OH 45662-2681
Phone (740) 356-8681

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address angela.gilliland@somc.medicity.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141119001993 OH Practitioner - Nurse Practitioner 7315169786 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Somc Medical Care Foundation, Inc. CurrentSince Oct 6, 2014 Accepting new patients
Somc Medical Care Foundation, Inc. Nurse Practitioner CurrentSince Oct 6, 2014 Accepting new patients

Locations

1735 27th St
Ste B06
Portsmouth, OH 45662
Phone (740) 356-7942

1805 27th St
Portsmouth, OH 45662
Phone (740) 356-5000

1248 Kinneys Ln
Portsmouth, OH 45662
Phone (740) 353-2131

835 W Emmitt Ave
Waverly, OH 45690
Phone (740) 356-5944

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608508800000",
    "number": "1235388968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1735 27TH ST STE B06",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456622681",
            "telephone_number": "740-356-8681",
            "fax_number": "740-353-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 W EMMITT AVE",
            "city": "WAVERLY",
            "state": "OH",
            "postal_code": "456901190",
            "telephone_number": "740-947-7662",
            "fax_number": "740-941-0099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLILAND",
        "first_name": "ANGELA",
        "middle_name": "D.",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-18",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.14669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "angela.gilliland@somc.medicity.net",
            "affiliation": "N",
            "address_1": "835 W Emmitt Ave",
            "city": "Waverly",
            "state": "OH",
            "country_code": "US",
            "postal_code": "456901190",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Waverly, OH

Sources for this page

Verify at the official NPI Registry.