Provider Demographics
NPI:1972530632
Name:ANTHONY, CLAUDIA WEIR (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:CLAUDIA
Middle Name:WEIR
Last Name:ANTHONY
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 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:901-227-3255
Mailing Address - Fax:601-984-5733
Practice Address - Street 1:1887 SPILLWAY RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047
Practice Address - Country:US
Practice Address - Phone:601-992-5532
Practice Address - Fax:601-992-5547
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR864863363LF0000X, 163WR0006X
MSF0715496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02158307Medicaid
MS429003YJ5DMedicare PIN