Healthcare Provider Details

I. General information

NPI: 1083352561
Provider Name (Legal Business Name): TERRAN RENEE TYLER B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W 10TH ST
MEDFORD OR
97501-3106
US

IV. Provider business mailing address

609 W 10TH ST
MEDFORD OR
97501-3106
US

V. Phone/Fax

Practice location:
  • Phone: 541-774-4900
  • Fax:
Mailing address:
  • Phone: 541-774-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1346883188
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: