Individual
MRS. ANGELA M TWILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4420 W MAIN ST STE A, LEAGUE CITY, TX 77573-1737
(832) 632-1015
(832) 905-5175
Mailing address
PO BOX 200993, HOUSTON, TX 77216-0993
(281) 784-1111
(281) 784-1555
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA04776
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182414601
—
TX
01
—
1871541607
TRICARE SOUTH
TX
01
—
8N9868
BCBSTX PROV NO.
TX
Enumeration date
05/04/2006
Last updated
02/24/2020
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