Healthcare Provider Details
I. General information
NPI: 1053440057
Provider Name (Legal Business Name): TANDY SUZANNE NOELLER ARNP, CNS, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 03/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2045 12TH STREET
SEVERY KS
67137-0093
US
IV. Provider business mailing address
2045 12TH STREET
SEVERY KS
67137-0093
US
V. Phone/Fax
- Phone: 620-736-2639
- Fax: 620-736-2639
- Phone: 620-736-2639
- Fax: 620-736-2639
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | 13-33753-081 |
| License Number State | KS |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1600X |
| Taxonomy | Continuing Education/Staff Development Registered Nurse |
| License Number | 13-33753-081 |
| License Number State | KS |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC3500X |
| Taxonomy | Cardiac Rehabilitation Registered Nurse |
| License Number | 13-33753-081 |
| License Number State | KS |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WD0400X |
| Taxonomy | Diabetes Educator Registered Nurse |
| License Number | 13-33753-081 |
| License Number State | KS |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WE0003X |
| Taxonomy | Emergency Registered Nurse |
| License Number | 13-33753-081 |
| License Number State | KS |
| # 6 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 163WW0000X |
| Taxonomy | Wound Care Registered Nurse |
| License Number | 13-33753-081 |
| License Number State | KS |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363L00000X |
| Taxonomy | Nurse Practitioner |
| License Number | 44916 |
| License Number State | KS |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 44916 |
| License Number State | KS |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LX0106X |
| Taxonomy | Occupational Health Nurse Practitioner |
| License Number | 44916 |
| License Number State | KS |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364S00000X |
| Taxonomy | Clinical Nurse Specialist |
| License Number | 74710 |
| License Number State | KS |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364SF0001X |
| Taxonomy | Family Health Clinical Nurse Specialist |
| License Number | 74710 |
| License Number State | KS |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364SH1100X |
| Taxonomy | Holistic Clinical Nurse Specialist |
| License Number | 74710 |
| License Number State | KS |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364SM0705X |
| Taxonomy | Medical-Surgical Clinical Nurse Specialist |
| License Number | 74710 |
| License Number State | KS |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 364SX0106X |
| Taxonomy | Occupational Health Clinical Nurse Specialist |
| License Number | 74710 |
| License Number State | KS |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
