Provider Demographics
NPI:1699473181
Name:FANNON, ARIELLE RENEE (NP)
Entity type:Individual
Prefix:
First Name:ARIELLE
Middle Name:RENEE
Last Name:FANNON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 704
Mailing Address - Street 2:
Mailing Address - City:DRYDEN
Mailing Address - State:VA
Mailing Address - Zip Code:24243-0704
Mailing Address - Country:US
Mailing Address - Phone:423-579-9448
Mailing Address - Fax:
Practice Address - Street 1:134 HILL ST
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:VA
Practice Address - Zip Code:24263-7965
Practice Address - Country:US
Practice Address - Phone:276-346-2011
Practice Address - Fax:276-346-0401
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186202363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner