Healthcare Provider Details

I. General information

NPI: 1407162621
Provider Name (Legal Business Name): RN FIRST ASSIST OF TYLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11924 COUNTY ROAD 2298
TYLER TX
75707-4948
US

IV. Provider business mailing address

11924 COUNTY ROAD 2298
TYLER TX
75707-4948
US

V. Phone/Fax

Practice location:
  • Phone: 903-752-5555
  • Fax: 888-329-6432
Mailing address:
  • Phone: 903-752-5555
  • Fax: 888-329-6432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number618259
License Number StateTX

VIII. Authorized Official

Name: MISTI STRAWN
Title or Position: PRESIDENT
Credential: RNFA
Phone: 903-752-5555