Angela Kim So, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

1116695 Issued in TX

Practice address

502 S Old Orchard LN Ste 126
Lewisville, TX 75067-4374

Phone

(972) 436-7962

NPI assigned

Jul 7, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Pediatric Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: angela.so.1@25734.direct.athenahealth.com

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.

• Pediplace

  • Pediatric Nurse Practitioner
  • Lewisville, TX
  • NPI 1467573311

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1404691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735257600000",
    "number": "1811303191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 S OLD ORCHARD LN STE 126",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750674374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 S OLD ORCHARD LN STE 126",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750674374",
            "telephone_number": "972-436-7962"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "408 S Beach Blvd Ste 111",
            "address_purpose": "LOCATION",
            "city": "Anaheim",
            "state": "CA",
            "postal_code": "928041866",
            "country_code": "US",
            "telephone_number": "714-826-8800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SO",
        "first_name": "ANGELA",
        "middle_name": "KIM",
        "name_prefix": "Mrs.",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-07",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "2267193",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95062551",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "95002627",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "1116695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Missy M. Smith, L.P.C.
• Natasha Smith, M.S., CCC-SLP
• Russell William Snook, MD
• Dawn Elaine Snow, PT
• Robert Gene Snyder, PHD
• Socios Imagining, LP
• Ylissa Soliz
• Daniel S Sone, DO
• Sonexus Health
• Sonexus Health Pharmacy Services

• Pediatric Nurse Practitioner in Lewisville, TX
• Providers in Lewisville, TX by specialty
• Pediatric Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2024; 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.