Healthcare Provider Details

I. General information

NPI: 1902715394
Provider Name (Legal Business Name): TIFFANY JOANN KING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 VICTOR AVE
WALTHILL NE
68067-5108
US

IV. Provider business mailing address

304 VICTOR AVE
WALTHILL NE
68067-5108
US

V. Phone/Fax

Practice location:
  • Phone: 918-406-8736
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number83383
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number114137
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: