Provider Demographics
NPI:1346206331
Name:TANNER, ANITA L (PA)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:L
Last Name:TANNER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2801 PARKLAWN DR
Mailing Address - Street 2:STE 100
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4224
Mailing Address - Country:US
Mailing Address - Phone:405-495-0070
Mailing Address - Fax:405-787-0062
Practice Address - Street 1:6820 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008
Practice Address - Country:US
Practice Address - Phone:405-495-0070
Practice Address - Fax:405-787-0062
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2020-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OKPA693363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100132360AMedicaid