Provider Demographics
NPI:1922303957
Name:STEVENS, ANITA KAY
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:KAY
Last Name:STEVENS
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 1:725 E POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-1800
Mailing Address - Country:US
Mailing Address - Phone:731-645-3474
Mailing Address - Fax:731-645-4530
Practice Address - Street 1:725 E POPLAR AVE
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-1800
Practice Address - Country:US
Practice Address - Phone:731-645-3474
Practice Address - Fax:731-645-4530
Is Sole Proprietor?:No
Enumeration Date:2011-01-23
Last Update Date:2011-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN98642163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health