Individual
ANGIE J WHITESELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1307 MAIN STREET, LOCKWOOD, MO 65682
(417) 232-4560
(417) 232-4611
Mailing address
1307 N MAIN ST, NEVADA, MO 64772-1129
(417) 232-4560
(417) 232-4561
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2003014018
MO
207V00000X
Obstetrics & Gynecology Physician
2003014018
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207274408
—
MO
01
—
431560263
TRICARE WEST
—
Enumeration date
06/17/2005
Last updated
01/09/2009
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