Healthcare Provider Details

I. General information

NPI: 1689581498
Provider Name (Legal Business Name): JOANNA R TYRELL LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 SOUTH 4TH STREET BUILDING 122 ROOM 302
LEAVENWORTH KS
66048
US

IV. Provider business mailing address

4101 SOUTH 4TH STREET TRAFFICWAY BUILDING 122 ROOM 302
LEAVENWORTH KS
66048
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-2000
  • Fax:
Mailing address:
  • Phone: 913-682-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number23-24969-102
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: