Andrea Jo Tanner, FNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

105472 Issued in WV

Practice address

273 Skidmore LN
Sutton, WV 26601-9272

Phone

(304) 765-4400

Fax

(304) 765-0354

NPI assigned

Sep 25, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WV

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Community Care of West Virginia, Inc.

  dba Community Care Connections of Buckhannon

  • Federally Qualified Health Center (FQHC)
  • Buckhannon, WV
  • NPI 1063048189
  Medicare reassignment NPD
• Community Care of West Virginia, Inc.

  dba Community Care of Bridgeport

  • Community/Behavioral Health Agency
  • Bridgeport, WV
  • NPI 1144811290
  NPD
• Community Care of West Virginia, Inc.

  dba Davis & Elkins College Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Elkins, WV
  • NPI 1235877267
  NPD
• Community Care of West Virginia, Inc.

  dba Community Care Pediatrics of Buckhannon

  • Federally Qualified Health Center (FQHC)
  • Buckhannon, WV
  • NPI 1255507810
  NPD
• Community Care of West Virginia, Inc.

  dba South Harrison High School Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Lost Creek, WV
  • NPI 1912258492
  NPD

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

{
    "created_epoch": "1600992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661904000000",
    "number": "1164039061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "273 SKIDMORE LN",
            "city": "SUTTON",
            "state": "WV",
            "postal_code": "266019272",
            "telephone_number": "304-765-4400",
            "fax_number": "304-765-0354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "273 SKIDMORE LN",
            "city": "SUTTON",
            "state": "WV",
            "postal_code": "266019272",
            "telephone_number": "304-765-4400",
            "fax_number": "304-765-0354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNER",
        "first_name": "ANDREA",
        "middle_name": "JO",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-25",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WV",
            "license": "105472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN, FNP-C",
            "identifier": "105472",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Elaine Stutler
• Marissa Summers
• Mary Jane Surface
• Rita Tackett
• Jacob Tallamy
• Debbie Lynn Tanner
• Ella Tanner
• Heather Leigh Tanner
• Peter Leon Tanner
• Megan Jane Tawney

• Nurse Practitioner in Sutton, WV
• Providers in Sutton, WV by specialty
• Nurse Practitioner in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.