Healthcare Provider Details

I. General information

NPI: 1578904348
Provider Name (Legal Business Name): TK FIRST ASSISTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 ARCADIA AVE
GILLETTE WY
82716-2230
US

IV. Provider business mailing address

616 ARCADIA AVE
GILLETTE WY
82716-2230
US

V. Phone/Fax

Practice location:
  • Phone: 307-660-7503
  • Fax: 888-329-6432
Mailing address:
  • Phone: 307-660-7503
  • Fax: 888-329-6432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number21791
License Number StateWY

VIII. Authorized Official

Name: MS. TAWNA LEA KILJANDER
Title or Position: PRESIDENT
Credential: RN, CNOR, RNFA
Phone: 307-660-7503