Individual
TIFFANY K MAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1902 S US HWY 59, CLINIC BLDG STE 1, PARSON, KS 67357
(417) 347-6400
(417) 347-6404
Mailing address
PO BOX 3810, JOPLIN, MO 64803-3810
(417) 347-6400
(417) 347-6404
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
45333
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100429300A
—
KS
05
—
100850610A
—
OK
01
—
160904
KS BCBS
KS
05
—
425962602
—
MO
01
—
500027083
RR MEDICARE
—
Enumeration date
06/20/2006
Last updated
03/16/2015
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