Provider Demographics
NPI:1558048249
Name:TAHY, JYLISSA NICOLE (LAT, ATC)
Entity Type:Individual
Prefix:MS
First Name:JYLISSA
Middle Name:NICOLE
Last Name:TAHY
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 S WATSON LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-2266
Mailing Address - Country:US
Mailing Address - Phone:970-570-7926
Mailing Address - Fax:
Practice Address - Street 1:1744 N ANDOVER RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-9472
Practice Address - Country:US
Practice Address - Phone:316-218-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-010712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer