Provider Demographics
NPI:1568262137
Name:TENNANT, TRISTA NICOLE
Entity type:Individual
Prefix:
First Name:TRISTA
Middle Name:NICOLE
Last Name:TENNANT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 W 21ST ST APT 1
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-5354
Mailing Address - Country:US
Mailing Address - Phone:308-238-1287
Mailing Address - Fax:
Practice Address - Street 1:2059 Q RD
Practice Address - Street 2:
Practice Address - City:HEARTWELL
Practice Address - State:NE
Practice Address - Zip Code:68945-2046
Practice Address - Country:US
Practice Address - Phone:308-224-7034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant