Basic Information
| Provider Information | |||||||||
| NPI: | 1275804270 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TANNER | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | T | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 850 | ||||||||
| Address2: | |||||||||
| City: | HURLEY | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395550850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2285882938 | ||||||||
| FaxNumber: | 2285889399 | ||||||||
| Practice Location | |||||||||
| Address1: | 7001 HWY 614 | ||||||||
| Address2: | |||||||||
| City: | HURLEY | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2285882938 | ||||||||
| FaxNumber: | 2285889399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2012 | ||||||||
| LastUpdateDate: | 04/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R205397-4 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.