Provider Demographics
NPI:1962642702
Name:FARGASON, ANNA WRIGHT (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:WRIGHT
Last Name:FARGASON
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:MISS
Other - First Name:ANNA
Other - Middle Name:ELIZABETH
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 2144
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36652-2144
Mailing Address - Country:US
Mailing Address - Phone:251-435-3153
Mailing Address - Fax:251-435-3052
Practice Address - Street 1:166 MOBILE INFIRMARY BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3510
Practice Address - Country:US
Practice Address - Phone:251-435-3153
Practice Address - Fax:251-435-3052
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1247133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ02375Medicare UPIN
0515554432WRIMedicare PIN