Healthcare Provider Details

I. General information

NPI: 1194581710
Provider Name (Legal Business Name): SYDNI NIERNBERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W 13TH ST
HAYS KS
67601-3613
US

IV. Provider business mailing address

105 W 13TH ST
HAYS KS
67601-3613
US

V. Phone/Fax

Practice location:
  • Phone: 785-621-4990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number83124
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF02240551
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number139940
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: