MEDICARE: MR. TANNER BRYCE EBANKS PA-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
1	363A00000X	Physician Assistant	PA3370	NV

General Provider Information

NPI Number	:	1447102256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TANNER BRYCE EBANKS PA-C

Provider Business Mailing Address
First Line	:	507 EMDEN ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89015-4642
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 E WINDMILL LN STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1933
Country	:	US
Telephone Number	:	702-645-7800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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