Provider Demographics
NPI:1508004110
Name:CRIST, ANNA MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MARIE
Last Name:CRIST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ZEBULON CT
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2420
Mailing Address - Country:US
Mailing Address - Phone:252-972-4357
Mailing Address - Fax:
Practice Address - Street 1:104 ZEBULON CT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2420
Practice Address - Country:US
Practice Address - Phone:252-972-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002854A363LA2200X
AZAP5105363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ218990Medicaid