Provider Demographics
NPI:1417174947
Name:TANNER, VALERIE KIM (NP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:KIM
Last Name:TANNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-381-1509
Practice Address - Street 1:1825 KNOXVILLE HWY
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-4120
Practice Address - Country:US
Practice Address - Phone:423-346-3600
Practice Address - Fax:833-908-2181
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO078117207P00000X, 363LP2300X
KS53-80475-111363LF0000X
FLARNP9276639363LF0000X
NC5015005363LF0000X
TN0000032826363LF0000X
TN32826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO836125005Medicare PIN