MEDICARE: MRS. TESSA SUZANNE CHANEY FNP

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	363LF0000X	Family Nurse Practitioner	0024171724	VA

General Provider Information

NPI Number	:	1467869040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TESSA SUZANNE CHANEY FNP

Provider Business Mailing Address
First Line	:	590 W RIDGE RD STE J
Second Line	:
City	:	WYTHEVILLE
State	:	VA
Zip	:	24382-1067
Country	:	US
Telephone Number	:	276-228-2405
Fax Number	:	833-941-2005

Provider Business Practice Location Address
First Line	:	590 W RIDGE RD STE J
Second Line	:
City	:	WYTHEVILLE
State	:	VA
Zip	:	24382-1067
Country	:	US
Telephone Number	:	276-228-2405
Fax Number	:	833-941-2005

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

Provider Enumeration Date	:	07/16/2014
Last Update Date	:	10/24/2024

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