Provider Demographics
NPI:1063044485
Name:ANTHONY, SUMMAR
Entity Type:Individual
Prefix:
First Name:SUMMAR
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 LINDEN DR
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-6961
Mailing Address - Country:US
Mailing Address - Phone:785-443-2651
Mailing Address - Fax:
Practice Address - Street 1:400 S. SANTE FE AVE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401
Practice Address - Country:US
Practice Address - Phone:785-452-6554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS124368163WM0705X
KS79491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163WM0705XNursing Service ProvidersRegistered NurseMedical-SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS124368OtherKSBN