Provider Demographics
NPI:1649821448
Name:ADAMS, TANYA (NP)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 W 109TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1303
Mailing Address - Country:US
Mailing Address - Phone:501-500-8807
Mailing Address - Fax:
Practice Address - Street 1:1501 ALDERSGATE RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6611
Practice Address - Country:US
Practice Address - Phone:501-666-7526
Practice Address - Fax:501-660-7876
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA006243363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner