Provider Demographics
NPI:1790033850
Name:SOUTH, ANNA KATHRYN (NP-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:KATHRYN
Last Name:SOUTH
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 1:135 KALASSAY DR
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-8726
Mailing Address - Country:US
Mailing Address - Phone:724-238-2613
Mailing Address - Fax:724-238-2614
Practice Address - Street 1:135 KALASSAY DR
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-8726
Practice Address - Country:US
Practice Address - Phone:724-238-2613
Practice Address - Fax:724-238-2614
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012128363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily