Healthcare Provider Details

I. General information

NPI: 1114357613
Provider Name (Legal Business Name): CARRIE ELIZABETH TYNER APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE ELIZABETH HANSEN NP

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S CLAIRBORNE RD STE 104
OLATHE KS
66062-1744
US

IV. Provider business mailing address

405 S CLAIRBORNE RD STE 2
OLATHE KS
66062-1774
US

V. Phone/Fax

Practice location:
  • Phone: 913-648-2266
  • Fax: 855-348-3430
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number268685
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-76185
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2013034520
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: