Provider Demographics
NPI:1740566777
Name:LOCKE, ANNA KIRBY (PA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:KIRBY
Last Name:LOCKE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-0176
Mailing Address - Country:US
Mailing Address - Phone:615-735-0700
Mailing Address - Fax:615-735-5480
Practice Address - Street 1:130 LEBANON HWY
Practice Address - Street 2:SUITE B
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-2955
Practice Address - Country:US
Practice Address - Phone:615-735-0700
Practice Address - Fax:615-735-5480
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2020363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical