Provider Demographics
NPI:1952351355
Name:ANTHONY, KEATA LORRAINE (FNP)
Entity type:Individual
Prefix:MRS
First Name:KEATA
Middle Name:LORRAINE
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2231
Mailing Address - Country:US
Mailing Address - Phone:731-989-0001
Mailing Address - Fax:731-989-5151
Practice Address - Street 1:116 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-4003
Practice Address - Country:US
Practice Address - Phone:731-989-0001
Practice Address - Fax:731-989-5151
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN#6159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621620777OtherTRICARE
TN4052228OtherBCBS
TN3908653Medicaid
TNMA0902886OtherDEA
TNS18886Medicare UPIN
TN3908653Medicaid