Healthcare Provider Details

I. General information

NPI: 1720823933
Provider Name (Legal Business Name): JAMESE TANNER MS, RD, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 COURTHOUSE RD
CHESTERFIELD VA
23832-6690
US

IV. Provider business mailing address

PO BOX 2947
CHESTERFIELD VA
23832-9118
US

V. Phone/Fax

Practice location:
  • Phone: 804-616-4378
  • Fax: 804-451-4586
Mailing address:
  • Phone: 804-616-4378
  • Fax: 804-451-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: