Healthcare Provider Details

I. General information

NPI: 1427891001
Provider Name (Legal Business Name): TYLER PENNINGTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TYLER HUSKEY

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 ROY CAMPBELL DRIVE SUITE 2
HAZARD KY
41701
US

IV. Provider business mailing address

34 MCCOY LN
HAZARD KY
41701-8127
US

V. Phone/Fax

Practice location:
  • Phone: 606-216-0488
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4017489
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: