Provider Demographics
NPI:1528223476
Name:ANDERSON, MARTHA JO (FNP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JO
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 BONHAM ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-3790
Mailing Address - Country:US
Mailing Address - Phone:903-739-2299
Mailing Address - Fax:903-739-2292
Practice Address - Street 1:2224 BONHAM ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-3790
Practice Address - Country:US
Practice Address - Phone:903-739-2299
Practice Address - Fax:903-739-2292
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX414565363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner