Healthcare Provider Details

I. General information

NPI: 1881617728
Provider Name (Legal Business Name): CASSIE A FLOYD TYNER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 BOGLE ST STE A
SOMERSET KY
42503-2815
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 606-677-0201
  • Fax: 606-677-0208
Mailing address:
  • Phone: 270-864-1472
  • Fax: 270-864-1693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number03008
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: