Healthcare Provider Details

I. General information

NPI: 1467051318
Provider Name (Legal Business Name): TYLYN LOUDERMILK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S 4TH ST W
BAKER MT
59313-9156
US

IV. Provider business mailing address

716 ADAIR AVE
ZANESVILLE OH
43701-2836
US

V. Phone/Fax

Practice location:
  • Phone: 406-778-3331
  • Fax:
Mailing address:
  • Phone: 740-891-9000
  • Fax: 740-891-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0027383
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-239010
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: