Healthcare Provider Details

I. General information

NPI: 1710267539
Provider Name (Legal Business Name): LEA ANN TYLER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 E 32ND ST
JOPLIN MO
64804-2878
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803-3810
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-4374
  • Fax:
Mailing address:
  • Phone: 417-347-4374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2012039527
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2012039527
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: