Provider Demographics
NPI:1245474998
Name:ANTHONY, STEVEN SCOTT (ACNP-BC)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:SCOTT
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:601-200-4644
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:969 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4606
Practice Address - Country:US
Practice Address - Phone:601-200-2280
Practice Address - Fax:601-200-0229
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS867664363LA2100X
MSR867664363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06629334Medicaid
MS$$$$$$$$$OtherBCBS OF MISSISSIPPI
MS06629334Medicaid