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General NPI Number Information
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NPI Number | 1639933567
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Entity Type | Individual
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Provider Name | THOMAS NICHOLAS PIENKOS APRN-CNP
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Gender | Male
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 6655 S YALE AVE
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City | TULSA
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State | OK
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Zip | 74136-3326
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Country | US
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Telephone | 918-481-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 4925 S BROADWAY AVE STE 4006
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City | WICHITA
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State | KS
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Zip | 67216-3716
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Country | US
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Telephone | 620-238-8408
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Fax | 833-415-2093
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | R0106739
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 53-83452-071
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 217068
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License Number State | OK
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