Provider Demographics
NPI:1326341843
Name:FARLEY, ANTHONY P (NPC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:P
Last Name:FARLEY
Suffix:
Gender:M
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-3821
Mailing Address - Country:US
Mailing Address - Phone:765-200-8008
Mailing Address - Fax:765-200-8022
Practice Address - Street 1:1821 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-3821
Practice Address - Country:US
Practice Address - Phone:765-200-8008
Practice Address - Fax:765-200-8022
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003475A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000689856OtherANTHEM
IN201004520Medicaid
OH3130909Medicaid
OH3130909Medicaid