Provider Demographics
NPI:1609253038
Name:TANKSLEY, JARRED PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:JARRED
Middle Name:PAUL
Last Name:TANKSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:14 MEDICAL PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5221
Mailing Address - Country:US
Mailing Address - Phone:828-586-7610
Mailing Address - Fax:828-586-7615
Practice Address - Street 1:14 MEDICAL PARK LOOP
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5221
Practice Address - Country:US
Practice Address - Phone:828-586-7610
Practice Address - Fax:828-586-7615
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2020-020712085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program