Provider Demographics
NPI:1447939921
Name:TIESZEN, LAURA FAYE (APRN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:FAYE
Last Name:TIESZEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 SW FOOT HILL DR
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-8425
Mailing Address - Country:US
Mailing Address - Phone:603-988-5818
Mailing Address - Fax:
Practice Address - Street 1:12541 FOSTER ST STE 200
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2307
Practice Address - Country:US
Practice Address - Phone:913-327-7505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health