Provider Demographics
NPI:1851645550
Name:PARTRIDGE, TANILLYA WILKERSON (FNP-C)
Entity Type:Individual
Prefix:
First Name:TANILLYA
Middle Name:WILKERSON
Last Name:PARTRIDGE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3058
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-3058
Mailing Address - Country:US
Mailing Address - Phone:336-504-6808
Mailing Address - Fax:866-610-0627
Practice Address - Street 1:293 MAIN STREET
Practice Address - Street 2:
Practice Address - City:YANCEYILLE
Practice Address - State:NC
Practice Address - Zip Code:27379
Practice Address - Country:US
Practice Address - Phone:336-504-6808
Practice Address - Fax:866-610-0627
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily