MEDICARE: ADRIANNE GABRIELLE VALERIE VANDIVER APRN

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	363LA2100X	Acute Care Nurse Practitioner	33063	TN
2	363LF0000X	Family Nurse Practitioner	33063	TN
3	363LP2300X	Primary Care Nurse Practitioner	33063	TN
4	363L00000X	Nurse Practitioner	33063	TN

General Provider Information

NPI Number	:	1467165431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIANNE GABRIELLE VALERIE VANDIVER APRN

Provider Business Mailing Address
First Line	:	63 RHETTS WAY
Second Line	:
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-3080
Country	:	US
Telephone Number	:	423-895-4689
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 E JACKSON BLVD STE 3
Second Line	:
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-1531
Country	:	US
Telephone Number	:	423-753-6077
Fax Number	:

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

Provider Enumeration Date	:	01/04/2023
Last Update Date	:	01/04/2023

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