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General NPI Number Information
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NPI Number | 1962060442
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Entity Type | Individual
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Provider Name | KAITLIN TENNYSON MD
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Gender | Female
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Dates
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Enumeration Date | 05/30/2019
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 1301 W 12TH AVE STE 301
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City | EMPORIA
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State | KS
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Zip | 66801-2590
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Country | US
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Telephone | 620-343-2376
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Fax | 620-343-5987
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Provider Business Mailing Address
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Address Line | 1201 W 12TH AVE
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City | EMPORIA
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State | KS
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Zip | 66801-2504
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Country | US
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Telephone | 620-343-6800
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Fax | 620-341-7821
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | TL0007768
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0446933
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License Number State | KS
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