Provider Demographics
NPI:1811036247
Name:DENT, TYESHA DAWN MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TYESHA
Middle Name:DAWN MARIE
Last Name:DENT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:TYESHA
Other - Middle Name:DAWN MARIE
Other - Last Name:SITSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:19680 BLUE JAY TRAIL CIR
Mailing Address - Street 2:
Mailing Address - City:LAWSON
Mailing Address - State:MO
Mailing Address - Zip Code:64062-7032
Mailing Address - Country:US
Mailing Address - Phone:701-209-0350
Mailing Address - Fax:
Practice Address - Street 1:10015 N AMBASSADOR DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-1364
Practice Address - Country:US
Practice Address - Phone:816-595-4000
Practice Address - Fax:701-584-3011
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2024-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021036928363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11228Medicaid
ND28537OtherBLUE CROSS BLUE SHIELD
ND28537OtherBLUE CROSS BLUE SHIELD