Healthcare Provider Details

I. General information

NPI: 1841900073
Provider Name (Legal Business Name): TYNEISHA S ORR DNP, APRN-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4313 STATE AVE
KANSAS CITY KS
66102-3734
US

IV. Provider business mailing address

4313 STATE AVE
KANSAS CITY KS
66102-3734
US

V. Phone/Fax

Practice location:
  • Phone: 913-342-2552
  • Fax:
Mailing address:
  • Phone: 913-342-2552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2023049466
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number114576
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5382774062
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2023049465
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number96872
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: