Provider Demographics
NPI:1558701565
Name:CORKER, ANASTASIA M (PMHNP)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:M
Last Name:CORKER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MEDICAL PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7886
Mailing Address - Country:US
Mailing Address - Phone:122-591-8115
Mailing Address - Fax:512-605-3726
Practice Address - Street 1:1401 MEDICAL PKWY STE C
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7886
Practice Address - Country:US
Practice Address - Phone:512-259-1811
Practice Address - Fax:512-605-3726
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX791262363LP0808X
TXAP123855363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty