Healthcare Provider Details

I. General information

NPI: 1942697941
Provider Name (Legal Business Name): SHANNA TUTTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 W 74TH ST
MERRIAM KS
66204-4004
US

IV. Provider business mailing address

12106 W 167TH TER
OVERLAND PARK KS
66221-7161
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2015020549
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number43-557625-121
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: