Healthcare Provider Details

I. General information

NPI: 1891091898
Provider Name (Legal Business Name): TYLER LEE HUNT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 S HIGHWAY 95
FORT MOHAVE AZ
86426-9225
US

IV. Provider business mailing address

5736 S DESERT LAKES DR
FORT MOHAVE AZ
86426-6721
US

V. Phone/Fax

Practice location:
  • Phone: 928-788-2273
  • Fax:
Mailing address:
  • Phone: 307-677-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number299658
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: