Provider Demographics
NPI:1083250864
Name:BOSIRE, TABITHA NYABOKE (RN)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:NYABOKE
Last Name:BOSIRE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:NYABOKE
Other - Last Name:OPANDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:15319 S NAVAHO DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3232
Mailing Address - Country:US
Mailing Address - Phone:913-602-9966
Mailing Address - Fax:
Practice Address - Street 1:10975 BENSON DR STE 380
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2161
Practice Address - Country:US
Practice Address - Phone:913-345-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-122197-072163WM0705X
MO2020019972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical