Provider Demographics
NPI:1871541607
Name:TWILLEY, ANGELA M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:M
Last Name:TWILLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:ST. JOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 200993
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-0993
Mailing Address - Country:US
Mailing Address - Phone:281-784-1111
Mailing Address - Fax:281-784-1555
Practice Address - Street 1:4420 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-1737
Practice Address - Country:US
Practice Address - Phone:832-632-1015
Practice Address - Fax:832-905-5175
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04776363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182414601Medicaid
TX1871541607OtherTRICARE SOUTH
TX8N9868OtherBCBSTX PROV NO.
TX1871541607OtherTRICARE SOUTH
TX8N9868OtherBCBSTX PROV NO.
TX8G5711Medicare PIN