Provider Demographics
NPI:1730689191
Name:FANNING, VALERIE ELAINE (DNP)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:ELAINE
Last Name:FANNING
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:ELAINE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:30 ROSEMOORE DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-7065
Mailing Address - Country:US
Mailing Address - Phone:404-820-0964
Mailing Address - Fax:
Practice Address - Street 1:30 ROSEMOORE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-7065
Practice Address - Country:US
Practice Address - Phone:404-820-0964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN128313363LA2200X, 363LG0600X, 363LP2300X
GA128313363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care