Healthcare Provider Details

I. General information

NPI: 1174466338
Provider Name (Legal Business Name): TYLER FORESEE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 S NEEDLES HWY STE 500
LAUGHLIN NV
89029-0815
US

IV. Provider business mailing address

746 E WINCHESTER ST STE 200
MURRAY UT
84107-8513
US

V. Phone/Fax

Practice location:
  • Phone: 702-703-1262
  • Fax:
Mailing address:
  • Phone: 801-485-6166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number321667
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: