Provider Demographics
NPI:1639549421
Name:ANTHONY, JOAN (NP-C)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 BROAD ST
Mailing Address - Street 2:PO BOX 175
Mailing Address - City:BAXTER
Mailing Address - State:TN
Mailing Address - Zip Code:38544
Mailing Address - Country:US
Mailing Address - Phone:931-858-2116
Mailing Address - Fax:931-858-2117
Practice Address - Street 1:319 BROAD ST
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:TN
Practice Address - Zip Code:38544-5117
Practice Address - Country:US
Practice Address - Phone:931-858-2116
Practice Address - Fax:931-858-2117
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20478363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology