Provider Demographics
NPI:1790073146
Name:KISSNER, DANAE ELAINE (PA)
Entity Type:Individual
Prefix:
First Name:DANAE
Middle Name:ELAINE
Last Name:KISSNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DANAE
Other - Middle Name:ELAINE
Other - Last Name:MILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2913 5TH AVE NE STE 101
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-6748
Mailing Address - Country:US
Mailing Address - Phone:855-255-1750
Mailing Address - Fax:855-255-0905
Practice Address - Street 1:141 N MARTINWOOD RD
Practice Address - Street 2:SUITE #10315
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5137
Practice Address - Country:US
Practice Address - Phone:865-406-2762
Practice Address - Fax:865-357-1238
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRCR0000000200173C00000X
TN8085225700000X
WAPA61113995363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No173C00000XOther Service ProvidersReflexologist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist