Provider Demographics
NPI:1942313655
Name:TINSLEY, MARY (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TINSLEY
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-3201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3151 EAST RIVER ROAD
Practice Address - Street 2:
Practice Address - City:NEWKIRK
Practice Address - State:OK
Practice Address - Zip Code:74647-0474
Practice Address - Country:US
Practice Address - Phone:580-362-1039
Practice Address - Fax:580-362-1039
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS45102363LF0000X
OKR0076203363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP35548Medicare UPIN