Provider Demographics
NPI:1679566822
Name:BOX THOMAS, ANITA (CFNP)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:BOX THOMAS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 S LAMAR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5375
Mailing Address - Country:US
Mailing Address - Phone:662-281-0112
Mailing Address - Fax:662-281-0943
Practice Address - Street 1:2908 S LAMAR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5375
Practice Address - Country:US
Practice Address - Phone:662-281-0112
Practice Address - Fax:662-281-0943
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR777188363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123850Medicaid
MS500000826Medicare ID - Type Unspecified
MSP25023Medicare UPIN