Provider Demographics
NPI:1780087304
Name:GREER, ANITA
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:GREER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:KOSCIUSKO
Mailing Address - State:MS
Mailing Address - Zip Code:39090-0372
Mailing Address - Country:US
Mailing Address - Phone:662-792-4101
Mailing Address - Fax:888-887-7401
Practice Address - Street 1:308 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:KOSCIUSKO
Practice Address - State:MS
Practice Address - Zip Code:39090-3322
Practice Address - Country:US
Practice Address - Phone:662-792-4101
Practice Address - Fax:888-887-7401
Is Sole Proprietor?:No
Enumeration Date:2014-09-28
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR858205363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner