Provider Demographics
NPI:1083659759
Name:RHODY, ANNE CARLENE (PA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:CARLENE
Last Name:RHODY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-6413
Mailing Address - Country:US
Mailing Address - Phone:715-905-0181
Mailing Address - Fax:
Practice Address - Street 1:6161 S YALE AVENUE
Practice Address - Street 2:ST. FRANCIS HOSPITAL ED/EMP
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74461
Practice Address - Country:US
Practice Address - Phone:918-494-5135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1813-023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical