Angel Sue Squire, APRN - PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

3014665 Issued in KY

Practice address

5300 Scottsville Rd
#50327
Bowling Green, KY 42104

Phone

(615) 813-0726

NPI assigned

Feb 27, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KY

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Magnolia Psychiatry

  • Psychiatric/Mental Health Nurse Practitioner
  • Louisville, KY
  • NPI 1255090510
  Medicare reassignment Authorized official
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  KY, Psychiatric/Mental Health

  Medicare reassignment NPD
• Onyx Regent Health & Wellness, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Bowling Green, KY
  • NPI 1720616212
  NPD (past)

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

{
    "created_epoch": "1582761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1699309666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50327",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421022927",
            "telephone_number": "615-813-0726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 SCOTTSVILLE RD",
            "address_2": "#50327",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "42104",
            "telephone_number": "615-813-0726"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2459 Mount Victor Ln",
            "address_purpose": "LOCATION",
            "city": "Bowling Green",
            "state": "KY",
            "postal_code": "421039061",
            "country_code": "US",
            "telephone_number": "270-935-5234",
            "fax_number": "270-935-5173",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4523 Shady Place Ct",
            "address_purpose": "LOCATION",
            "city": "Bowling Green",
            "state": "KY",
            "postal_code": "421044423",
            "country_code": "US",
            "telephone_number": "937-285-0414",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "141 Parker St Ste 306",
            "address_purpose": "LOCATION",
            "city": "Maynard",
            "state": "MA",
            "postal_code": "017542180",
            "country_code": "US",
            "telephone_number": "866-991-2103",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "839 Wren Rd",
            "address_purpose": "LOCATION",
            "city": "Goodlettsville",
            "state": "TN",
            "postal_code": "370722316",
            "country_code": "US",
            "telephone_number": "615-766-8081",
            "fax_number": "615-766-8083",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SQUIRE",
        "first_name": "ANGEL",
        "middle_name": "SUE",
        "credential": "APRN - PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-27",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.363146",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KY",
            "license": "1143292",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "APN0000027631",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F403253-01",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "APRN.CNP.0027948",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KY",
            "license": "3014665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100691750",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Spine Stop Bowling Green, PLLC
• Allison Spine, APRN
• Audrey Spinks
• Springfield Radiology Associates, PC
• Diana Sprinkle, NP-C
• Sankar Srinivasan, MD
• Bonnie Susan Stagner, APRN
• Allen Stahl, PEER SUPPORT SPEC.
• Patrick Stalcup, MD
• Steffan A. Stambaugh, OTR

• Psychiatric/Mental Health Nurse Practitioner in Bowling Green, KY
• Providers in Bowling Green, KY by specialty
• Psychiatric/Mental Health Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.