Provider Demographics
NPI:1568500957
Name:KING, TYSHA A (MSN- CRNA)
Entity Type:Individual
Prefix:MS
First Name:TYSHA
Middle Name:A
Last Name:KING
Suffix:
Gender:F
Credentials:MSN- CRNA
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Mailing Address - Street 1:12752 KINGSTON PIKE
Mailing Address - Street 2:STE E202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-0948
Mailing Address - Country:US
Mailing Address - Phone:865-777-0909
Mailing Address - Fax:865-777-0910
Practice Address - Street 1:7191 S YALE AVENUE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6326
Practice Address - Country:US
Practice Address - Phone:865-777-0909
Practice Address - Fax:865-777-0910
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001015978367500000X
OK0090574367500000X
OK90574367500000X
MO2001015678367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO917262602Medicaid
AR159877001OtherARK BLUE SHIELD
OK900522349OtherMEDCIARE GROUP PIN
MO175118OtherMO BLUE SHIELD
OK621867095001OtherBLUE CROSS/BLUE SHIELD
OK200125380AMedicaid
AR159877001Medicaid
OKP00632204OtherRAILROAD MEDICARE
AR159877001OtherARK BLUE SHIELD
AR159877001Medicaid