Provider Demographics
NPI:1467165431
Name:VANDIVER, ADRIANNE GABRIELLE VALERIE (APRN)
Entity Type:Individual
Prefix:
First Name:ADRIANNE
Middle Name:GABRIELLE VALERIE
Last Name:VANDIVER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ADRIANNE
Other - Middle Name:GABRIELLE VALERIE
Other - Last Name:CABLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:63 RHETTS WAY
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-3080
Mailing Address - Country:US
Mailing Address - Phone:423-895-4689
Mailing Address - Fax:
Practice Address - Street 1:1003 E JACKSON BLVD STE 3
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-1531
Practice Address - Country:US
Practice Address - Phone:423-753-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33063363LA2100X, 363LF0000X, 363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care