Healthcare Provider Details

I. General information

NPI: 1447710025
Provider Name (Legal Business Name): TYSON SCOTT SESSIONS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 E OVERLAND RD
MERIDIAN ID
83642-6757
US

IV. Provider business mailing address

2001 W 86TH ST 3 NORTH
INDIANAPOLIS IN
46260-1991
US

V. Phone/Fax

Practice location:
  • Phone: 208-884-1333
  • Fax: 208-489-4015
Mailing address:
  • Phone: 317-338-6089
  • Fax: 317-338-2851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberO-1928
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: