MEDICARE: TNI-KSO PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1215003314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TNI-KSO PC

Provider Business Mailing Address
First Line	:	6465 S YALE AVE
Second Line	:	SUITE 507
City	:	TULSA
State	:	OK
Zip	:	74136-7823
Country	:	US
Telephone Number	:	918-481-2763
Fax Number	:	918-481-2775

Provider Business Practice Location Address
First Line	:	6465 S YALE AVE
Second Line	:	SUITE 507
City	:	TULSA
State	:	OK
Zip	:	74136-7823
Country	:	US
Telephone Number	:	918-481-2763
Fax Number	:	918-481-2775

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	LESA ANDERSON
Credential	:
Telephone Number	:	918-779-4948

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	06/03/2026

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Directions to “TNI-KSO PC ” Practice Location

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