Individual
DR. JESSICA TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3600 E HARRY ST, WICHITA, KS 67218-3713
(316) 689-6173
Mailing address
3600 E HARRY ST, WICHITA, KS 67218-3713
(316) 689-6173
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301078717
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106560
MEDICARE PTAN
KS
Enumeration date
08/25/2006
Last updated
11/16/2016
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