1962563940 NPI number — MRS. BARBARA COLLINS TANNER FNP

Table of content: MRS. BARBARA COLLINS TANNER FNP (NPI 1962563940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962563940 NPI number — MRS. BARBARA COLLINS TANNER FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TANNER
Provider First Name:
BARBARA
Provider Middle Name:
COLLINS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLLINS
Provider Other First Name:
BARBARA
Provider Other Middle Name:
JANET
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962563940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
117 EAST KING HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDEN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-623-9711
Provider Business Mailing Address Fax Number:
336-623-2434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 NORTH PIERCE STREET
Provider Second Line Business Practice Location Address:
MOREHEAD HIGH SCHOOL STUDENT HEALTH CENTER
Provider Business Practice Location Address City Name:
EDEN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-623-3699
Provider Business Practice Location Address Fax Number:
336-623-3699
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  200698 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7000157 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1241L . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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