Provider Demographics
NPI:1578784997
Name:TANNER, SHIRLEY ALEMA (ANP)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:ALEMA
Last Name:TANNER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 TONI DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-3016
Mailing Address - Country:US
Mailing Address - Phone:870-732-5448
Mailing Address - Fax:870-732-1734
Practice Address - Street 1:900 N 7TH ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-2001
Practice Address - Country:US
Practice Address - Phone:870-735-3842
Practice Address - Fax:870-394-4817
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01595363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner