Provider Demographics
NPI:1205881307
Name:FALLS, ANITA J (CFNP)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:J
Last Name:FALLS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 E MADISON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851-2428
Mailing Address - Country:US
Mailing Address - Phone:662-456-4277
Mailing Address - Fax:662-456-9589
Practice Address - Street 1:1002 E MADISON ST STE 2
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851-2428
Practice Address - Country:US
Practice Address - Phone:662-456-4277
Practice Address - Fax:662-456-9589
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR857133363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119223Medicaid
MS00119223Medicaid