Healthcare Provider Details

I. General information

NPI: 1033149786
Provider Name (Legal Business Name): TAHNYA LYTLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 MADISON RD SUITE 400
CINCINNATI OH
45209-2276
US

IV. Provider business mailing address

2727 MADISON RD SUITE 400
CINCINNATI OH
45209-2276
US

V. Phone/Fax

Practice location:
  • Phone: 513-321-4333
  • Fax:
Mailing address:
  • Phone: 513-321-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.002650
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: