Provider Demographics
NPI:1124806856
Name:STATLER, ANNA (PA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:STATLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 BRASFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-1188
Mailing Address - Country:US
Mailing Address - Phone:706-616-7216
Mailing Address - Fax:
Practice Address - Street 1:201 GOVERNORS DR SW FL 1
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5171
Practice Address - Country:US
Practice Address - Phone:256-533-1600
Practice Address - Fax:256-539-0856
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.2271363A00000X
363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical