Tanner Davis, DNP
Individual provider Active NPI Family Nurse Practitioner · Dewey, AZ
NPI 1962201491 · NPPES record last updated Jul 21, 2026
Key facts
- NPI
- 1962201491
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 341074 (AZ)
- Practice address
- 12075 E State Route 69 Ste B
Dewey, AZ 86327-4569 - Phone
- (928) 772-1673
- Fax
- (928) 772-1674
- NPI assigned
- Mar 8, 2025
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Minuteclinic Diagnostic of Kansas PA
Practice addresses (Care Compare)
8101 Clayton Rd
Clayton, MO 63117-1103
Phone (866) 389-2727
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250409002553 | MO | Practitioner - Nurse Practitioner | 7113441320 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles (1 of 5)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Minuteclinic Diagnostic of Kansas PA | Multi-Specialty | Current |
Accepting new patients |
Locations
3825 S Noland Rd
Independence, MO 64055
Phone (816) 254-6002
8101 Clayton Rd
Saint Louis, MO 63117
Phone (314) 726-2124
8021 Watson Rd
Webster Groves, MO 63119
Phone (314) 963-0398
Networks
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H9678
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 341074 | AZ | Yes |
Addresses
Primary practice location
12075 E State Route 69 Ste B
Dewey, AZ 86327-4569
Mailing address
12075 E State Route 69 Ste B
Dewey, AZ 86327-4569
Phone (928) 772-1673
Other practice location 1
8101 Clayton Rd
Clayton, MO 63117-1103
Phone (314) 726-2124
Other practice location 2
3251 N Windsong Dr
Prescott Valley, AZ 86314-1222
Phone (928) 772-2582
Other providers in Dewey, AZ
- Choice Medical Walk in PLLC
- Christin Emberlin LLC
- Clarence & Jeanne Kinsley, Dba
- CRL Mobile Examiner
- Richard L D'Armand
- Amy Larissa Dedea
- Cheryl Dixon-Burns
- Crystal Lynn Dunn
- Janice Dunn
- Danielle Marie Durnan
All providers in Dewey, AZ · Family Nurse Practitioner in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.