Provider Demographics
NPI:1669023420
Name:ANTHONY, ANNA CHAMBERLAIN (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:CHAMBERLAIN
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 E 36TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-3102
Mailing Address - Country:US
Mailing Address - Phone:405-209-9963
Mailing Address - Fax:
Practice Address - Street 1:2000 S WHEELING AVE STE 1000
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5648
Practice Address - Country:US
Practice Address - Phone:918-748-8467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14029363A00000X
OK4706363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant