Healthcare Provider Details

I. General information

NPI: 1326340928
Provider Name (Legal Business Name): TYRA TANNER DNP, RD, ANP, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 COURTHOUSE RD STE 202
CHESTERFIELD VA
23832-6687
US

IV. Provider business mailing address

PO BOX 2947
CHESTERFIELD VA
23832-9118
US

V. Phone/Fax

Practice location:
  • Phone: 804-616-4378
  • Fax: 804-616-4378
Mailing address:
  • Phone: 804-616-4378
  • Fax: 804-616-4378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2010029866
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001206597
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024172296
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024172296
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number0015000947
License Number StateVA
# 6
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024172296
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: