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NPI Code Detail

MEDICARE: SUE DAVIS TANNER RN,FNP-C

MEDICARE: SUE DAVIS TANNER RN,FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner233019TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275585531
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUE DAVIS TANNER RN,FNP-C
Provider Business Mailing Address
First Line : 24275 KATY FWY STE 400
Second Line :
City : KATY
State : TX
Zip : 77494-7267
Country : US
Telephone Number : 346-387-7171
Fax Number :
Provider Business Practice Location Address
First Line : 24275 KATY FWY STE 400
Second Line :
City : KATY
State : TX
Zip : 77494-7267
Country : US
Telephone Number : 346-387-7171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 05/07/2019

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