Healthcare Provider Details

I. General information

NPI: 1194387068
Provider Name (Legal Business Name): KARMIN TYLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20231 PAUL REVERE CIR
EAGLE RIVER AK
99577-8476
US

IV. Provider business mailing address

20231 PAUL REVERE CIR
EAGLE RIVER AK
99577-8476
US

V. Phone/Fax

Practice location:
  • Phone: 907-538-1904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: