Provider Demographics
NPI:1982625646
Name:CALHOUN, ANNA KATHRYN (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:KATHRYN
Last Name:CALHOUN
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 1:250 EXECUTIVE PARK BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1534
Mailing Address - Country:US
Mailing Address - Phone:336-999-8295
Mailing Address - Fax:336-999-8296
Practice Address - Street 1:250 EXECUTIVE PARK BLVD STE 105
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1534
Practice Address - Country:US
Practice Address - Phone:336-999-8295
Practice Address - Fax:336-999-8296
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103582363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC103582OtherSTATE LICENSE NUMBER
NCMC1066960OtherDEA