Angel Isom
Homemaker in Olive Branch, MS. Individual provider (NPI-1).
NPI number1063008985
StatusActive
Last updated in NPPESMay 2, 2022
Details
- NPI
- 1063008985
- Entity type
- Individual (NPI-1)
- Name
- Angel Isom
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Dec 15, 2020
- Certification date
- May 2, 2022
- Last updated
- May 2, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 376J00000X | Homemaker | – | – | Yes |
| 246RP1900X | Technician, Pathology, Phlebotomy | 22-1648 | MS |
Practice location
4615 Dupree Rd.Olive Branch, MS 38654-5197
Phone 662-544-2536
Mailing address
4615 Dupree Rd.Olive Branch, MS 38654-5197
Phone 662-544-2536
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