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General NPI Number Information
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NPI Number | 1912158080
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Entity Type | Individual
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Provider Name | MELISSA S TANKERSLEY CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 05/19/2014
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Provider Practice Location Address
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Address Line | 1 MEDICAL PARK BLVD
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City | BRISTOL
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State | TN
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Zip | 37620-7430
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Country | US
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Telephone | 423-844-2686
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Fax | 423-844-2688
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Provider Business Mailing Address
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Address Line | 1007 CLIFFVIEW DR
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City | GRAY
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State | TN
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Zip | 37615-5210
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Country | US
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Telephone | 423-477-2016
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 80093
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 13690
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License Number State | TN
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