Provider Demographics
NPI:1699907022
Name:DESELMS, ANITA CAROLYN (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:CAROLYN
Last Name:DESELMS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-6700
Mailing Address - Country:US
Mailing Address - Phone:307-632-6403
Mailing Address - Fax:307-632-6426
Practice Address - Street 1:1202 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-6700
Practice Address - Country:US
Practice Address - Phone:307-632-6403
Practice Address - Fax:307-632-6426
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY100460992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily