Provider Demographics
NPI:1386809382
Name:FREELON, TIFFANY ANN (RN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:FREELON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-3841
Mailing Address - Country:US
Mailing Address - Phone:816-214-6987
Mailing Address - Fax:
Practice Address - Street 1:10500 E 46TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-3841
Practice Address - Country:US
Practice Address - Phone:816-214-6987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-20
Last Update Date:2008-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006007589163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse