Healthcare Provider Details

I. General information

NPI: 1285130997
Provider Name (Legal Business Name): TANNER HURLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PLANTATION RD STE 3
BLACKSBURG VA
24060-3821
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 540-961-1058
  • Fax: 540-961-1668
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number0101281789
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: