Healthcare Provider Details

I. General information

NPI: 1952351355
Provider Name (Legal Business Name): KEATA LORRAINE ANTHONY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W MAIN ST
HENDERSON TN
38340-4003
US

IV. Provider business mailing address

116 W MAIN ST
HENDERSON TN
38340-2231
US

V. Phone/Fax

Practice location:
  • Phone: 731-989-0001
  • Fax: 731-989-5151
Mailing address:
  • Phone: 731-989-0001
  • Fax: 731-989-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN#6159
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: