Provider Demographics
NPI:1427124213
Name:PETERSON, ANITA (CRNA)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 11225
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-2225
Mailing Address - Country:US
Mailing Address - Phone:423-892-5602
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:975 E. THIRD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-778-7806
Practice Address - Fax:423-778-2360
Is Sole Proprietor?:No
Enumeration Date:2006-11-26
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN112460163W00000X
TNAPN10854367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAN445621OtherWELLCARE (GA MEDICAID)
AL009968920Medicaid
TN1512360Medicaid
TN430075451OtherRAILROAD MEDICARE
TN4026811OtherBLUE CROSS BLUE SHIELD TN
GA000926373AMedicaid
NC8052326Medicaid
AL009968920Medicaid