Healthcare Provider Details

I. General information

NPI: 1629213665
Provider Name (Legal Business Name): TIFFANY KOEHN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W BROADWAY ST
NEWTON KS
67114-2632
US

IV. Provider business mailing address

308 W BROADWAY ST
NEWTON KS
67114-2632
US

V. Phone/Fax

Practice location:
  • Phone: 316-248-8993
  • Fax: 316-444-6407
Mailing address:
  • Phone: 316-248-8993
  • Fax: 316-444-6407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: