Provider Demographics
NPI:1033728555
Name:IVEY, ANTHONY (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:IVEY
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2342 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3563
Mailing Address - Country:US
Mailing Address - Phone:785-342-9172
Mailing Address - Fax:
Practice Address - Street 1:2342 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3563
Practice Address - Country:US
Practice Address - Phone:785-342-9172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-113835-011163W00000X
KS53-79651-011363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse