=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649821448
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANYA ADAMS NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2019
-----------------------------------------------------
Last Update Date | 09/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1501 ALDERSGATE RD
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-6611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-666-7526
-----------------------------------------------------
Fax | 501-660-7876
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4401 W 109TH ST STE 200
-----------------------------------------------------
City | LEAWOOD
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66211-1303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-500-8807
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | A006243
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------