Active NPI
Slawomir Tycner, PMHNP
- Psychiatric/Mental Health Nurse Practitioner
- Pueblo, CO
National Provider Identifier
1811233448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- APN.0990527-NP
- Practice address
- 1600 W 24TH St
Pueblo, CO 81003-1411 - Phone
- (719) 546-4637
- Fax
- (719) 546-4484
- NPI assigned
- Dec 31, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | APN.0990527-NP | CO | Primary |
Addresses
Primary practice location
1600 W 24TH St
Pueblo, CO 81003-1411
Mailing address
1600 W 24TH St
Pueblo, CO 81003-1411
Phone (719) 546-4637
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231213000135 | CO | Order and Referring Only - Nurse Practitioner | 3678922804 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1356912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1356912000000",
"number": "1811233448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 W 24TH ST",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810031411",
"telephone_number": "719-546-4637",
"fax_number": "719-546-4484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 W 24TH ST",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810031411",
"telephone_number": "719-546-4637",
"fax_number": "719-546-4484"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TYCNER",
"first_name": "SLAWOMIR",
"credential": "PMHNP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-12-31",
"last_updated": "2012-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "CO",
"license": "APN.0990527-NP",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.