Healthcare Provider Details

I. General information

NPI: 1619570769
Provider Name (Legal Business Name): TIFFANY K YOWELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BLUFF ST
WINNEBAGO NE
68071-9703
US

IV. Provider business mailing address

5221 MEADOW SWEET LN
SHAWNEE KS
66226-3601
US

V. Phone/Fax

Practice location:
  • Phone: 402-878-2231
  • Fax:
Mailing address:
  • Phone: 913-687-3237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5379705
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2021032480
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number113847
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: