Angelica Hennessey, LPN, PHARMACY TECH
Individual provider Active NPI Licensed Practical Nurse · Wildwood, GA
NPI 1750131603 · NPPES record last updated Mar 25, 2024
Key facts
- NPI
- 1750131603
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 100354 (GA)
- Practice address
- 1236 Highway 299
Wildwood, GA 30757-4003 - Phone
- (423) 428-0045
- NPI assigned
- Mar 25, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri-State Treatment,LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 100354 | GA | Yes |
Addresses
Primary practice location
1236 Highway 299
Wildwood, GA 30757-4003
Mailing address
1236 Highway 299
Wildwood, GA 30757-4003
Phone (423) 428-0045
Other providers in Wildwood, GA
- Sandra Belizaire
- Lisa Edwards
- Jocelyn Garcia
- John David Harrington
- Tiffany Johnson
- Nana Yaa Kwarteng
- Abrianna McGill
- Latosha Muir
- Sheena Parker
All providers in Wildwood, GA · Licensed Practical Nurse in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.