Provider Demographics
NPI:1932259363
Name:NACKLEY, ANNA C (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:C
Last Name:NACKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 PARK PLACE AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6033
Mailing Address - Country:US
Mailing Address - Phone:817-540-1157
Mailing Address - Fax:817-267-0522
Practice Address - Street 1:1701 PARK PLACE AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6033
Practice Address - Country:US
Practice Address - Phone:817-540-1157
Practice Address - Fax:817-267-0522
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1945207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G72256Medicare UPIN