Provider Demographics
NPI:1437167681
Name:ANTHONY, VANESSA ANN (APN)
Entity Type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:ANN
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17085 HIGHWAY 5
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-7134
Mailing Address - Country:US
Mailing Address - Phone:501-257-6903
Mailing Address - Fax:501-257-6855
Practice Address - Street 1:4300 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5446
Practice Address - Country:US
Practice Address - Phone:501-257-6903
Practice Address - Fax:501-257-6855
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA00186363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care