Angels of Ark, LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

ANGELS OF ARK, LLC

Practice address

133 Pinner LN Apt 4
Medford, OR 97501-7528

Phone

(281) 650-0945

Fax

(541) 245-7494

NPI assigned

Aug 22, 2025

Last updated

Aug 22, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Manga Telidevara, NPNPI 1497474373

Title

Owner

Phone

(281) 650-0945

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Manga Telidevara, NP

  • Family Nurse Practitioner
  • Montgomery, TX
  • NPI 1497474373
  NPD Authorized official

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

{
    "created_epoch": "1755820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755820800000",
    "number": "1285512798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 PINNER LN APT 4",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975017528",
            "telephone_number": "281-650-0945",
            "fax_number": "541-245-7494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 PINNER LN APT 4",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975017528",
            "telephone_number": "281-650-0945",
            "fax_number": "541-245-7494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGELS OF ARK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-22",
        "last_updated": "2025-08-22",
        "certification_date": "2025-08-22",
        "status": "A",
        "authorized_official_last_name": "TELIDEVARA",
        "authorized_official_first_name": "MANGA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "281-650-0945",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in Medford, OR
• Providers in Medford, OR by specialty
• Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.