Provider Demographics
NPI:1205861333
Name:SALYER, VANESSA T (FNP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:T
Last Name:SALYER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:T
Other - Last Name:GENTRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 W STONE DR
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:1990 HOLTON AVE E
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-3350
Practice Address - Country:US
Practice Address - Phone:276-523-8635
Practice Address - Fax:276-523-8636
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166926363LF0000X
TN15465363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1205861333Medicaid
TN103I504413Medicare PIN
VAVV1166BMedicare PIN
TN103I509247Medicare PIN
VAVV1166AMedicare PIN