Healthcare Provider Details

I. General information

NPI: 1366941650
Provider Name (Legal Business Name): TYLER FEUERBORN APRN-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1538 N LEWIS AVE
TULSA OK
74110-2535
US

IV. Provider business mailing address

1515 S BUCKNER BLVD STE 141
DALLAS TX
75217-1794
US

V. Phone/Fax

Practice location:
  • Phone: 918-400-7001
  • Fax: 539-202-5070
Mailing address:
  • Phone: 214-974-9126
  • Fax: 469-574-0383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9407120
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number228312
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1061932
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN9407120
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: