Healthcare Provider Details

I. General information

NPI: 1659255859
Provider Name (Legal Business Name): THE HEALTHY PLACE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3158 N CLANTON ST
BUCKEYE AZ
85396-7707
US

IV. Provider business mailing address

2942 N 24TH ST STE 115
PHOENIX AZ
85016-7849
US

V. Phone/Fax

Practice location:
  • Phone: 602-603-7375
  • Fax: 602-563-8218
Mailing address:
  • Phone: 602-603-7375
  • Fax: 602-563-8218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TYLER ANDERSON
Title or Position: CO-OWNER
Credential:
Phone: 586-612-0476