Provider Demographics
| NPI: | 1053395228 |
|---|---|
| Name: | TIEPERMAN, SABRA LEIGH (RN ARNP) |
| Entity type: | Individual |
| Prefix: | |
| First Name: | SABRA |
| Middle Name: | LEIGH |
| Last Name: | TIEPERMAN |
| Suffix: | |
| Gender: | F |
| Credentials: | RN ARNP |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | 821 WESTRIDGE DR |
| Mailing Address - Street 2: | |
| Mailing Address - City: | NEWTON |
| Mailing Address - State: | KS |
| Mailing Address - Zip Code: | 67114-1670 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 620-755-4235 |
| Mailing Address - Fax: | 833-449-0970 |
| Practice Address - Street 1: | 821 WESTRIDGE DR |
| Practice Address - Street 2: | |
| Practice Address - City: | NEWTON |
| Practice Address - State: | KS |
| Practice Address - Zip Code: | 67114-1670 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 620-755-4235 |
| Practice Address - Fax: | 833-449-0970 |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2005-12-01 |
| Last Update Date: | 2024-09-03 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| KS | 53-74804-102 | 364SP0809X, 364SP0807X, 364SP0808X, 364SP0811X, 364SP0812X, 364SP0813X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 364SP0809X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Adult |
| No | 364SP0807X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Adolescent |
| No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health |
| No | 364SP0811X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Chronically Ill |
| No | 364SP0812X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Community |
| No | 364SP0813X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Geropsychiatric |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| KS | 30004436160004 | Medicaid | |
| P64814 | Medicare UPIN |
