MEDICARE: TYLER JOHNSON CNM

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	176B00000X	Midwife	2016015074	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	277003758	OTHER	IL	FULL PRACTICE AUTHORITY APRN

General Provider Information

NPI Number	:	1710335427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER JOHNSON CNM

Provider Business Mailing Address
First Line	:	2628 E GLENWOOD ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-3422
Country	:	US
Telephone Number	:	417-860-8465
Fax Number	:

Provider Business Practice Location Address
First Line	:	2628 E GLENWOOD ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-3422
Country	:	US
Telephone Number	:	417-860-8465
Fax Number	:

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

Provider Enumeration Date	:	06/03/2016
Last Update Date	:	11/20/2025

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