Healthcare Provider Details

I. General information

NPI: 1972530632
Provider Name (Legal Business Name): CLAUDIA WEIR ANTHONY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 SPILLWAY RD
BRANDON MS
39047
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 103
MEMPHIS TN
38120-9446
US

V. Phone/Fax

Practice location:
  • Phone: 601-992-5532
  • Fax: 601-992-5547
Mailing address:
  • Phone: 901-227-3255
  • Fax: 601-984-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR864863
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberR864863
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0715496
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: