Healthcare Provider Details

I. General information

NPI: 1942360326
Provider Name (Legal Business Name): TYLER NEPHROLOGY ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 MEDICAL DR
TYLER TX
75701-2130
US

IV. Provider business mailing address

1133 MEDICAL DR
TYLER TX
75701-2130
US

V. Phone/Fax

Practice location:
  • Phone: 903-595-5486
  • Fax: 903-595-5128
Mailing address:
  • Phone: 903-595-5486
  • Fax: 903-595-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA MILLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 903-595-5486