MEDICARE: TYRA WEBB

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	363L00000X	Nurse Practitioner	39779	TN

General Provider Information

NPI Number	:	1972479368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYRA WEBB

Provider Business Mailing Address
First Line	:	1306 MONTVALE STATION RD
Second Line	:
City	:	MARYVILLE
State	:	TN
Zip	:	37803-5814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7499 POPLAR PIKE
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-5934
Country	:	US
Telephone Number	:	662-883-4198
Fax Number	:

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

Provider Enumeration Date	:	10/14/2025
Last Update Date	:	03/24/2026

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Directions to “ TYRA WEBB ” Practice Location

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