Provider Demographics
NPI:1982038642
Name:TANNER, KIMBERLEY A (FNP-C)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:A
Last Name:TANNER
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 1:3887 LEEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2435
Mailing Address - Country:US
Mailing Address - Phone:216-702-0910
Mailing Address - Fax:
Practice Address - Street 1:3887 LEEWOOD RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2435
Practice Address - Country:US
Practice Address - Phone:216-702-0910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2025-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.350893-163W00000X
OHAPRN.CNP.0040565202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine