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General NPI Number Information
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NPI Number | 1447102256
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Entity Type | Individual
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Provider Name | TANNER BRYCE EBANKS PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/12/2026
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 1617 E WINDMILL LN STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89123-1933
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Country | US
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Telephone | 702-645-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 507 EMDEN ST
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City | HENDERSON
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State | NV
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Zip | 89015-4642
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA3370
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License Number State | NV
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