MEDICARE: HEATHER E TYE RN

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	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	702477	OTHER	TN	TEXAS BOARD OF NURSING

General Provider Information

NPI Number	:	1417586934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER E TYE RN

Provider Business Mailing Address
First Line	:	9100 W INTERSTATE 10 STE 210
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-3149
Country	:	US
Telephone Number	:	210-928-3900
Fax Number	:	210-855-5974

Provider Business Practice Location Address
First Line	:	9100 W INTERSTATE 10 STE 210
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-3149
Country	:	US
Telephone Number	:	210-928-3900
Fax Number	:	210-855-5974

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

Provider Enumeration Date	:	04/06/2020
Last Update Date	:	04/06/2020

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Directions to “ HEATHER E TYE RN” Practice Location

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