Provider Demographics
NPI:1093789059
Name:HOSKINSON, TRESA (APRN, CPNP, MN)
Entity Type:Individual
Prefix:
First Name:TRESA
Middle Name:
Last Name:HOSKINSON
Suffix:
Gender:F
Credentials:APRN, CPNP, MN
Other - Prefix:MRS
Other - First Name:TJ
Other - Middle Name:
Other - Last Name:HOSKINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN,CNS, MN
Mailing Address - Street 1:2101 N WALDRON ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1131
Mailing Address - Country:US
Mailing Address - Phone:620-669-2500
Mailing Address - Fax:
Practice Address - Street 1:2101 N WALDRON ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1131
Practice Address - Country:US
Practice Address - Phone:620-669-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45185363L00000X
KS53-74100-012364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100248040Medicaid
KS013270Medicare ID - Type Unspecified
KS100248040Medicaid