Provider Demographics
NPI:1740774678
Name:ANTHONY, TRICIA KELLY
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:KELLY
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 DELAFIELD PL NW APT 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4193
Mailing Address - Country:US
Mailing Address - Phone:202-760-7388
Mailing Address - Fax:
Practice Address - Street 1:901 1ST ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-1403
Practice Address - Country:US
Practice Address - Phone:202-760-7388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA00606286376K00000X
DCHHA13738374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA13738OtherHOME HEALTH AIDE
DCNA00606286OtherCERTIFIED NURSING ASSISTANT