Provider Demographics
NPI:1578841896
Name:KEVAK, TANA RENEE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TANA
Middle Name:RENEE
Last Name:KEVAK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TANA
Other - Middle Name:RENEE
Other - Last Name:HAUGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:921 MINERAL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26351-1342
Mailing Address - Country:US
Mailing Address - Phone:304-462-7322
Mailing Address - Fax:304-462-3419
Practice Address - Street 1:921 MINERAL RD STE 101
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:WV
Practice Address - Zip Code:26351
Practice Address - Country:US
Practice Address - Phone:304-354-9244
Practice Address - Fax:304-354-5963
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV46966363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner