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NPI Code Detail

MEDICARE: CHERYL TAN

MEDICARE: CHERYL TAN
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
1207Q00000XFamily Medicine Physician45942KS
2363LF0000XFamily Nurse Practitioner45942KS
3363LP0808XPsychiatric/Mental Health Nurse Practitioner45942KS

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2178951OTHERKSMEDICARE
4PTAN 016291004OTHERKSMEDICARE - WPS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588760003
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERYL TAN
Provider Business Mailing Address
First Line : 716 S HEDGEWOOD CIR
Second Line :
City : ANDOVER
State : KS
Zip : 67002-6601
Country : US
Telephone Number : 316-844-7309
Fax Number : 316-747-8028
Provider Business Practice Location Address
First Line : 6525 E MAINSGATE RD
Second Line :
City : WICHITA
State : KS
Zip : 67226-1062
Country : US
Telephone Number : 316-844-7309
Fax Number : 316-747-8028
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2006
Last Update Date : 01/09/2024

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Directions to “ CHERYL TAN ” Practice Location

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