Provider Demographics
NPI:1336950542
Name:JOHN, ANITHA (NP)
Entity type:Individual
Prefix:
First Name:ANITHA
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 TRANSCENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-0888
Mailing Address - Country:US
Mailing Address - Phone:720-724-8660
Mailing Address - Fax:
Practice Address - Street 1:333 E BETHANY DR STE J100
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3827
Practice Address - Country:US
Practice Address - Phone:512-887-5843
Practice Address - Fax:512-493-0485
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1086730363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health