Provider Demographics
NPI:1053805523
Name:DEATON, ANNA BETH SPARKS (PA)
Entity type:Individual
Prefix:
First Name:ANNA BETH
Middle Name:SPARKS
Last Name:DEATON
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Gender:
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:2208 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7593
Mailing Address - Country:US
Mailing Address - Phone:910-763-3333
Mailing Address - Fax:910-799-2943
Practice Address - Street 1:2208 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7593
Practice Address - Country:US
Practice Address - Phone:910-763-3333
Practice Address - Fax:910-799-2943
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-08120363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant