Healthcare Provider Details

I. General information

NPI: 1063801157
Provider Name (Legal Business Name): CHRISTY MARIE TENNISSEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 S ALL HALLOWS ST
WICHITA KS
67217-1053
US

IV. Provider business mailing address

2950 S ALL HALLOWS ST
WICHITA KS
67217-1053
US

V. Phone/Fax

Practice location:
  • Phone: 316-323-1400
  • Fax: 833-974-3860
Mailing address:
  • Phone: 316-323-1400
  • Fax: 833-974-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number76648
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number85300
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: