Provider Demographics
NPI:1891509360
Name:TANNER, KEVIN
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:TANNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7643 W LITTLE KANAWHA HWY
Mailing Address - Street 2:
Mailing Address - City:MUNDAY
Mailing Address - State:WV
Mailing Address - Zip Code:26152-8023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7643 W LITTLE KANAWHA HWY
Practice Address - Street 2:
Practice Address - City:MUNDAY
Practice Address - State:WV
Practice Address - Zip Code:26152-8023
Practice Address - Country:US
Practice Address - Phone:304-354-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant