Healthcare Provider Details

I. General information

NPI: 1144992314
Provider Name (Legal Business Name): TANNER RAPP RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W A ST
YAKIMA WA
98902-2605
US

IV. Provider business mailing address

611 W A ST
YAKIMA WA
98902-2605
US

V. Phone/Fax

Practice location:
  • Phone: 509-961-6336
  • Fax: 509-452-1004
Mailing address:
  • Phone: 509-961-6336
  • Fax: 509-452-1004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61273001
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61273001
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP61469690
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN60912791
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: