Healthcare Provider Details

I. General information

NPI: 1912596735
Provider Name (Legal Business Name): TYLER JENKINS NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 UNIVERSITY DR
AMHERST MA
01002-8900
US

IV. Provider business mailing address

165 UNIVERSITY DR
AMHERST MA
01002-8900
US

V. Phone/Fax

Practice location:
  • Phone: 413-256-0421
  • Fax: 413-256-4242
Mailing address:
  • Phone: 413-256-0421
  • Fax: 413-256-4242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2292412
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2292412
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: