MEDICARE: DR. MINDY KATE TANNER AU.D.

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	231H00000X	Audiologist	AT005180	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00347618	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6084244	OTHER		CIGNA
2	2773101000	OTHER	PA	INDEPENDENCE BLUE CROSS
3	BR1902248	OTHER	PA	HIGHMARK BLUE SHIELD
4	1351615	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1548208499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINDY KATE TANNER AU.D.

Provider Business Mailing Address
First Line	:	175 CUSHION PEAK RD
Second Line	:
City	:	WERNERSVILLE
State	:	PA
Zip	:	19565-9493
Country	:	US
Telephone Number	:	610-413-7820
Fax Number	:	610-404-8045

Provider Business Practice Location Address
First Line	:	560 VAN REED RD STE 205
Second Line	:
City	:	WYOMISSING
State	:	PA
Zip	:	19610-1799
Country	:	US
Telephone Number	:	610-404-8025
Fax Number	:	610-404-8045

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	12/12/2025

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Directions to “ DR. MINDY KATE TANNER AU.D.” Practice Location

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