Individual provider Active NPI

Casey Tanner, PNP

  • Pediatric Nurse Practitioner
  • Atlanta, GA
National Provider Identifier
1154076123
Registry record updated Feb 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
RN220734 Issued in GA
Practice address
5461 Meridian Mark Rd Ste 570
Atlanta, GA 30342-2807
Phone
(404) 785-6895
Fax
(404) 785-6896
NPI assigned
Feb 17, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X RN220734 GA Primary

Addresses

Primary practice location

5461 Meridian Mark Rd Ste 570
Atlanta, GA 30342-2807

Mailing address

5461 Meridian Mark Rd Ste 570
Atlanta, GA 30342-2807
Phone (404) 785-6895

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230807001979 GA Order and Referring Only - Nurse Practitioner 8921469958

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Choa Multispecialty, LLC Pediatrics PastSince Feb 24, 2022 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645056000000",
    "number": "1154076123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5461 MERIDIAN MARK RD STE 570",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303422807",
            "telephone_number": "404-785-6895",
            "fax_number": "404-785-6896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5461 MERIDIAN MARK RD STE 570",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303422807",
            "telephone_number": "404-785-6895",
            "fax_number": "404-785-6896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNER",
        "first_name": "CASEY",
        "credential": "PNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-17",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "GA",
            "license": "RN220734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.