Provider Demographics
NPI:1780810721
Name:ELLERBY-BROWN, ANITRA DOLORES (FNP-BC, CNM)
Entity type:Individual
Prefix:
First Name:ANITRA
Middle Name:DOLORES
Last Name:ELLERBY-BROWN
Suffix:
Gender:F
Credentials:FNP-BC, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 CAYER LN C
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-7384
Mailing Address - Country:US
Mailing Address - Phone:931-548-2500
Mailing Address - Fax:931-548-2503
Practice Address - Street 1:2504 CAYER LN C
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-7384
Practice Address - Country:US
Practice Address - Phone:931-548-2500
Practice Address - Fax:931-548-2503
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13719363LF0000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513989Medicaid
TN4292536OtherBCBS
TN103I509141Medicare UPIN