Individual
MS. TYSHA A KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN- CRNA
Contact information
Practice address
7191 S YALE AVENUE, TULSA, OK 74136-6326
(865) 777-0909
(865) 777-0910
Mailing address
12752 KINGSTON PIKE, STE E202, KNOXVILLE, TN 37934-0948
(865) 777-0909
(865) 777-0910
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
0090574
OK
367500000X
Certified Registered Nurse Anesthetist
2001015678
MO
367500000X
Certified Registered Nurse Anesthetist
2001015978
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
90574
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
159877001
ARK BLUE SHIELD
AR
05
—
159877001
—
AR
01
—
175118
MO BLUE SHIELD
MO
05
—
200125380A
—
OK
01
—
621867095001
BLUE CROSS/BLUE SHIELD
OK
01
—
900522349
MEDCIARE GROUP PIN
OK
05
—
917262602
—
MO
01
—
P00632204
RAILROAD MEDICARE
OK
Enumeration date
02/01/2007
Last updated
02/01/2011
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