Provider Demographics
NPI:1528303039
Name:NICKEL, TISHA LYNN (APRN)
Entity type:Individual
Prefix:
First Name:TISHA
Middle Name:LYNN
Last Name:NICKEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TISHA
Other - Middle Name:LYNN
Other - Last Name:COUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:8919 PARALLEL PKWY STE 270
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-1655
Mailing Address - Country:US
Mailing Address - Phone:913-334-6800
Mailing Address - Fax:913-334-0875
Practice Address - Street 1:8919 PARALLEL PKWY STE 270
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1655
Practice Address - Country:US
Practice Address - Phone:913-334-6800
Practice Address - Fax:913-334-0875
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75755-022363LF0000X
KS75755363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily