Most Relevant Information
Provider Data
| NPI Number: | 1003588963 |
| Provider Name: | ANNA ELISE FENTON NP |
| Entity Type: | Individual |
| Taxonomy Code: | 363L00000X |
| Specialty: | Nurse Practitioner |
| License Number: | 1055530 |
Most Important Dates
| Enumeration Date: | 09/29/2021 |
| Last Updated: | 09/29/2021 |
Provider Practice Location
6210 S BROADWAY AVE
TYLER
TX
757034413
Practice Location Phone/Fax
| Phone: | 9035792700 |
| Fax: | 9035792799 |
Provider Mailing Location
6210 S BROADWAY AVE
TYLER
TX
757034413
Provider Mailing Phone/Fax
| Phone: | 9035792700 |
| Fax: | 9035792799 |