Bernadette G Addison-Tanner

Key facts

NPI

1750143566

Entity type

Individual (NPI type 1)

Primary specialty

Case Management Registered Nurse 163WC0400X

License

152562 (MO)

Practice address

915 N Grand Blvd
Saint Louis, MO 63106-1621

Phone

(314) 652-4100

Fax

(314) 289-6595

NPI assigned

Jan 26, 2024

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 26, 2024.

{
    "created_epoch": "1706227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1750143566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 HERN AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631352644",
            "telephone_number": "314-398-6406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 N GRAND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631061621",
            "telephone_number": "314-652-4100",
            "fax_number": "314-289-6595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADDISON-TANNER",
        "first_name": "BERNADETTE",
        "middle_name": "G",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-26",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "MO",
            "license": "152562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

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• Andrews Addae, CRNA
• Jessica Addai, RN
• Carla Adderley
• Denise R Addis
• Sarah Addison, MD
• Additional Care Services LLC
• Adds Health Services, LLC
• Oluwafunmilayo Beverly Adebayo-Adonis, MD
• Oluwatoyin Olufunke Adegboyega, FNP

All providers in Saint Louis, MO · Case Management Registered Nurse in Missouri