Healthcare Provider Details

I. General information

NPI: 1811036247
Provider Name (Legal Business Name): TYESHA DAWN MARIE DENT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TYESHA DAWN MARIE SITSLER PA-C

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 09/22/2024
Certification Date: 09/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10015 N AMBASSADOR DR
KANSAS CITY MO
64153-1364
US

IV. Provider business mailing address

19680 BLUE JAY TRAIL CIR
LAWSON MO
64062-7032
US

V. Phone/Fax

Practice location:
  • Phone: 816-595-4000
  • Fax: 701-584-3011
Mailing address:
  • Phone: 701-209-0350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2021036928
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: