1568500957 NPI number — MS. TYSHA A KING MSN- CRNA

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568500957 NPI number — MS. TYSHA A KING MSN- CRNA

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KING

Provider First Name:

TYSHA

Provider Middle Name:

A

Provider Name Prefix Text:

MS.

Provider Name Suffix Text:

Provider Credential Text:

MSN- CRNA

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1568500957

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/01/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

12752 KINGSTON PIKE

Provider Second Line Business Mailing Address:

STE E202

Provider Business Mailing Address City Name:

KNOXVILLE

Provider Business Mailing Address State Name:

TN

Provider Business Mailing Address Postal Code:

37934-0948

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

865-777-0909

Provider Business Mailing Address Fax Number:

865-777-0910

Provider First Line Business Practice Location Address:

7191 S YALE AVENUE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

TULSA

Provider Business Practice Location Address State Name:

OK

Provider Business Practice Location Address Postal Code:

74136-6326

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

865-777-0909

Provider Business Practice Location Address Fax Number:

865-777-0910

Provider Enumeration Date:

02/01/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 367500000X , with the licence number:  2001015978 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: 0090574 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: 90574 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 367500000X , with the licence number: 2001015678 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 917262602 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
• Identifier: 159877001 . This is a "ARK BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 900522349 . This is a "MEDCIARE GROUP PIN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
• Identifier: 175118 . This is a "MO BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: 621867095001 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
• Identifier: 200125380A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
• Identifier: 159877001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
• Identifier: P00632204 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".