Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | AP125673 | TX |
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP125673 | TX |
N | 363LG0600X | Nurse Practitioner - Gerontology | AP125673 | TX |
NPI | 1083010763 |
---|---|
Provider Name | Anjetta Granvinetta Atkins |
First Address | Temple, TX 76502-7321 |
Second Address | Temple, TX 76508-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2014 |
Last Update Date | 07/11/2014 |