MEDICARE: MRS. SHIRLEY JEAN TYLER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	875	CO

General Provider Information

NPI Number	:	1306825773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHIRLEY JEAN TYLER PA-C

Provider Business Mailing Address
First Line	:	1650 COCHRANE CIR
Second Line	:	EVANS FAMILY MEDICINE CLINIC
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4603
Country	:	US
Telephone Number	:	719-524-4068
Fax Number	:	719-526-7312

Provider Business Practice Location Address
First Line	:	1650 COCHRANE CIR
Second Line	:	EVANS FAMILY MEDICINE CLINIC
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4603
Country	:	US
Telephone Number	:	719-524-4068
Fax Number	:	719-526-7312

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	11/02/2010

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