Provider Demographics
NPI:1740582923
Name:ANTHONY, JENNIFER KAY (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KAY
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CORLEY CIR
Mailing Address - Street 2:
Mailing Address - City:WAKE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5861
Mailing Address - Country:US
Mailing Address - Phone:903-223-8584
Mailing Address - Fax:
Practice Address - Street 1:116 CORLEY CIR
Practice Address - Street 2:
Practice Address - City:WAKE VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75501-5861
Practice Address - Country:US
Practice Address - Phone:903-223-8584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX696151367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered