Provider Demographics
NPI:1093729709
Name:NANNEY, JOSEPH C (PA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:NANNEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5576
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-5576
Mailing Address - Country:US
Mailing Address - Phone:423-926-6266
Mailing Address - Fax:423-926-7599
Practice Address - Street 1:101 MED TECH PKWY
Practice Address - Street 2:SUITE 305
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4007
Practice Address - Country:US
Practice Address - Phone:423-926-6266
Practice Address - Fax:423-926-7599
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA979363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P55634Medicare UPIN
TN103I976358Medicare PIN
3689231Medicare ID - Type Unspecified