Healthcare Provider Details

I. General information

NPI: 1891129003
Provider Name (Legal Business Name): ANNA S VANEATON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3114 BROWNS MILL RD
JOHNSON CITY TN
37604-1417
US

IV. Provider business mailing address

871 VINES FARM LN
JONESBOROUGH TN
37659-1243
US

V. Phone/Fax

Practice location:
  • Phone: 423-631-0432
  • Fax:
Mailing address:
  • Phone: 423-915-6953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4484
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: