Provider Demographics
NPI:1295796449
Name:KROGER, ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:KROGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E APPLE ST
Mailing Address - Street 2:STE 6258
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2939
Mailing Address - Country:US
Mailing Address - Phone:937-208-5300
Mailing Address - Fax:937-208-5650
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:STE 6258
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-5300
Practice Address - Fax:937-208-5650
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-001998363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP99976Medicare UPIN
OHPA21804Medicare PIN