Healthcare Provider Details

I. General information

NPI: 1629213665
Provider Name (Legal Business Name): TIFFANY KOEHN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 MEDICAL CENTER DR
NEWTON KS
67114-8778
US

IV. Provider business mailing address

720 MEDICAL CENTER DR
NEWTON KS
67114-8778
US

V. Phone/Fax

Practice location:
  • Phone: 316-283-6103
  • Fax: 316-283-1333
Mailing address:
  • Phone: 316-283-6103
  • Fax: 316-283-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number102604
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number75458
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number75458
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: