Healthcare Provider Details

I. General information

NPI: 1295604536
Provider Name (Legal Business Name): DANIEL LEE TYREE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 W BADDOUR PKWY STE 240
LEBANON TN
37087-1510
US

IV. Provider business mailing address

1420 W BADDOUR PKWY STE 240
LEBANON TN
37087-1510
US

V. Phone/Fax

Practice location:
  • Phone: 615-444-4126
  • Fax: 855-785-2890
Mailing address:
  • Phone: 615-444-4126
  • Fax: 855-785-2890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number35797
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: