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General NPI Number Information
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NPI Number | 1245879642
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Entity Type | Individual
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Provider Name | KYLIE ANN TANGNEY CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 01/02/2020
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 3716 MELROSE AVE NW
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City | ROANOKE
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State | VA
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Zip | 24017-2716
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Country | US
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Telephone | 540-362-0360
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Fax |
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Provider Business Mailing Address
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Address Line | 3716 MELROSE AVE NW
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City | ROANOKE
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State | VA
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Zip | 24017-2716
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Country | US
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Telephone | 540-797-9385
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 0024177607
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License Number State | VA
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