Angelique Vickie Cole

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

3642 Blue Gum St
Clearlake, CA 95422-7939

Phone

(707) 266-9150

NPI assigned

Feb 28, 2025

Last updated

Feb 28, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Angelique Chacon Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Evergreen Team Holdings LLC - Supporting Bright Futures Dba

  dba Freedom REI Homes Corp

  • Case Management Agency
  • Lower Lake, CA
  • NPI 1811795370

  Lodging

  NPD Authorized official

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

{
    "created_epoch": "1740700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740700800000",
    "number": "1811794597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16745 BIG BEAR RD",
            "city": "LOWER LAKE",
            "state": "CA",
            "postal_code": "954579712",
            "telephone_number": "707-206-5204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3642 BLUE GUM ST",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954227939",
            "telephone_number": "707-266-9150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLE",
        "first_name": "ANGELIQUE",
        "middle_name": "VICKIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-02-28",
        "last_updated": "2025-02-28",
        "certification_date": "2025-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "177F00000X",
            "taxonomy_group": "",
            "desc": "Lodging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELIQUE",
            "last_name": "CHACON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John Clarke
• Clear Lake Physical Therapy Inc
• Clear Script Company Inc (Morans Pharmacy)
• Clear Script Company Inc
• Richard Allan Cohn Jr.
• Randall Cole
• Community Care
• Shaunie Marie Conatser
• Eleanor Marie Cook
• Lyndsey Irene Cook, CADTP #9868

• Community Health Worker in Clearlake, CA
• Providers in Clearlake, CA by specialty
• Community Health Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 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.