Provider Demographics
NPI:1265435671
Name:BAKER-ROSS, ANITA LYNN (APN, CNM)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:LYNN
Last Name:BAKER-ROSS
Suffix:
Gender:F
Credentials:APN, CNM
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:LYNN
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN, CNM
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:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:1312 BISHOP ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5406
Practice Address - Country:US
Practice Address - Phone:731-885-5150
Practice Address - Fax:731-885-7584
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN11590367A00000X
KY3012814367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY11169OtherAMERICAN MIDWIFERY CERTIFICATION BOARD (AMCB)
TN3380640OtherMEDICARE GROUP
TN11590OtherAPN LICENSE
TN3380640Medicaid