Individual
TYLER J ANTENEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
750 W D AVE, KINGMAN, KS 67068-1266
(620) 532-0295
(855) 483-0002
Mailing address
750 W D AVE, KINGMAN, KS 67068-1266
(620) 532-0295
(855) 483-0002
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1501947
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20114690A
—
KS
05
—
30003916630006
—
KS
Enumeration date
10/19/2016
Last updated
09/03/2025
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