Provider Demographics
NPI:1235172321
Name:SMALL, ANNA M (FNP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:SMALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 W WHEATLAND RD STE 152
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3404
Mailing Address - Country:US
Mailing Address - Phone:214-467-0432
Mailing Address - Fax:214-467-0635
Practice Address - Street 1:3920 W WHEATLAND RD STE 152
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237
Practice Address - Country:US
Practice Address - Phone:214-467-0432
Practice Address - Fax:214-467-0635
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP113251363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185019001Medicaid
TX8Y0260OtherBLUE CROSS BLUE SHIELD
Q74498Medicare UPIN
TX185019001Medicaid