Healthcare Provider Details

I. General information

NPI: 1275438269
Provider Name (Legal Business Name): TANNER KALI COLLEY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 WASHINGTON AVE
WHEELING WV
26003-6243
US

IV. Provider business mailing address

2100 WILDFLOWER CIR APT 203
WASHINGTON PA
15301-1298
US

V. Phone/Fax

Practice location:
  • Phone: 304-243-2000
  • Fax:
Mailing address:
  • Phone: 484-433-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP037425
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: