Individual
TIANA GAINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3311 E MURDOCK ST, WICHITA, KS 67208-3054
(316) 689-9178
(316) 689-9811
Mailing address
PO BOX 8035, WICHITA, KS 67208-0035
(316) 689-9135
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
76469
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003719432
MEDICARE
—
Enumeration date
06/25/2014
Last updated
12/02/2015
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