Provider Demographics
NPI:1487277703
Name:TYREE, RIANN PAIGE (PA)
Entity type:Individual
Prefix:MRS
First Name:RIANN
Middle Name:PAIGE
Last Name:TYREE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RIANN
Other - Middle Name:PAIGE
Other - Last Name:HEFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:721 W KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67054-1633
Mailing Address - Country:US
Mailing Address - Phone:620-723-2127
Mailing Address - Fax:620-723-1037
Practice Address - Street 1:721 W KANSAS AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KS
Practice Address - Zip Code:67054-1633
Practice Address - Country:US
Practice Address - Phone:620-723-2127
Practice Address - Fax:207-231-0376
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02417363AM0700X
KS261QR1300X
KST-05424363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004727620001Medicaid