Provider Demographics
NPI:1205133196
Name:WARREN, TISHA MARLENE (APRN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TISHA
Middle Name:MARLENE
Last Name:WARREN
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FREDERICA ST.
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301
Mailing Address - Country:US
Mailing Address - Phone:270-684-0023
Mailing Address - Fax:270-684-0065
Practice Address - Street 1:3600 FREDERICA ST
Practice Address - Street 2:SUITE B
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301
Practice Address - Country:US
Practice Address - Phone:270-684-0023
Practice Address - Fax:270-684-0065
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006838363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner