Healthcare Provider Details

I. General information

NPI: 1710335427
Provider Name (Legal Business Name): TYLER JOHNSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2628 E GLENWOOD ST
SPRINGFIELD MO
65804-3422
US

IV. Provider business mailing address

2628 E GLENWOOD ST
SPRINGFIELD MO
65804-3422
US

V. Phone/Fax

Practice location:
  • Phone: 417-860-8465
  • Fax:
Mailing address:
  • Phone: 417-860-8465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number2016015074
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: