Provider Demographics
NPI:1396900882
Name:CROSSBOURNE, ANEISHA SELENE (MBBS)
Entity type:Individual
Prefix:DR
First Name:ANEISHA
Middle Name:SELENE
Last Name:CROSSBOURNE
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:DR
Other - First Name:ANEISHA
Other - Middle Name:SELENE
Other - Last Name:CROSSBOURNE-MOSES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:250 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1760
Mailing Address - Country:US
Mailing Address - Phone:270-796-6540
Mailing Address - Fax:270-796-6576
Practice Address - Street 1:250 PARK ST
Practice Address - Street 2:INPATIENT MEDICAL ASSOCIATES
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1760
Practice Address - Country:US
Practice Address - Phone:270-796-6540
Practice Address - Fax:270-796-6576
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP879208M00000X
KY44567208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist