Provider Demographics
NPI:1063066637
Name:KOLE, ANAYA TINA (PMHNP-BC, FNP-C)
Entity type:Individual
Prefix:
First Name:ANAYA
Middle Name:TINA
Last Name:KOLE
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 ALDEN ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-5164
Mailing Address - Country:US
Mailing Address - Phone:816-824-7349
Mailing Address - Fax:
Practice Address - Street 1:7300 W 110TH ST STE 700
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2332
Practice Address - Country:US
Practice Address - Phone:816-824-7349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017002712163WN0800X
MO2019043204363L00000X
KS53-79161-012363LF0000X, 363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily