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Individual

TANNER GRANT COLE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
FNP-C

Contact information

Practice address
327 MEDICAL PARK DR, BRIDGEPORT, WV 26330-9006
(681) 342-1100
Mailing address
911 BUNNER RIDGE RD, FAIRMONT, WV 26554-5070
(304) 657-6981

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
107935
WV

Other

Enumeration date
01/08/2024
Last updated
06/12/2024
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