Angela Denise Pack, CM

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

20916 Issued in OK

Practice address

1515 W Chickasaw Ave
Sallisaw, OK 74955-7201

Phone

(918) 775-2657

Fax

(918) 775-0439

NPI assigned

Aug 26, 2008

Last updated

Aug 26, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1219708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219708800000",
    "number": "1417104027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 W CHICKASAW AVE",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749557201",
            "telephone_number": "918-775-2657",
            "fax_number": "918-775-0439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 W CHICKASAW AVE",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749557201",
            "telephone_number": "918-775-2657",
            "fax_number": "918-775-0439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACK",
        "first_name": "ANGELA",
        "middle_name": "DENISE",
        "name_prefix": "Mrs.",
        "credential": "CM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-26",
        "last_updated": "2008-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OK",
            "license": "20916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Case Manager/Care Coordinator in Sallisaw, OK
• Providers in Sallisaw, OK by specialty
• Case Manager/Care Coordinator in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; 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.