Provider Demographics
NPI:1154945848
Name:FAILS, ANNA (FNP)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:FAILS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 MS HIGHWAY 42
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SUMRALL
Mailing Address - State:MS
Mailing Address - Zip Code:39482
Mailing Address - Country:US
Mailing Address - Phone:769-307-6995
Mailing Address - Fax:769-307-6996
Practice Address - Street 1:1039 MS HIGHWAY 42
Practice Address - Street 2:SUITE 3
Practice Address - City:SUMRALL
Practice Address - State:MS
Practice Address - Zip Code:39482
Practice Address - Country:US
Practice Address - Phone:769-307-6995
Practice Address - Fax:769-307-6996
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09604894Medicaid