Provider Demographics
NPI: | 1417146374 |
---|---|
Name: | HARKER, ANITA KENKAREY (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ANITA |
Middle Name: | KENKAREY |
Last Name: | HARKER |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 3889 |
Mailing Address - Street 2: | |
Mailing Address - City: | JOHNSON CITY |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37602-3889 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 423-794-5742 |
Mailing Address - Fax: | 423-283-9480 |
Practice Address - Street 1: | 301 MED TECH PKWY STE 240 |
Practice Address - Street 2: | |
Practice Address - City: | JOHNSON CITY |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37604-2641 |
Practice Address - Country: | US |
Practice Address - Phone: | 423-794-5520 |
Practice Address - Fax: | 423-282-6940 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-10-17 |
Last Update Date: | 2021-06-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 45185 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 4243133 | Other | BC/BS |
KY | 7100097850 | Medicaid | |
TN | P00867840 | Other | RAILROAD MEDICARE |
VA | 1417146374 | Medicaid | |
TN | 1514470 | Medicaid | |
NC | 1417146374 | Medicaid | |
NC | 1417146374 | Medicaid |