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NPI Code Detail

MEDICARE: DOMINIQUE ANAYA PA-C

MEDICARE: DOMINIQUE ANAYA PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1376233841
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINIQUE ANAYA PA-C
Provider Business Mailing Address
First Line : 650 JOEL DR
Second Line :
City : FORT CAMPBELL
State : KY
Zip : 42223-5318
Country : US
Telephone Number : 270-798-8400
Fax Number :
Provider Business Practice Location Address
First Line : 650 JOEL DR
Second Line :
City : FORT CAMPBELL
State : KY
Zip : 42223-5318
Country : US
Telephone Number : 270-798-8400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2023
Last Update Date : 01/13/2026

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Directions to “ DOMINIQUE ANAYA PA-C” Practice Location

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