Healthcare Provider Details

I. General information

NPI: 1821518663
Provider Name (Legal Business Name): HEATHER T TYREE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 TATE SPRINGS RD
LYNCHBURG VA
24501-1109
US

IV. Provider business mailing address

1901 TATE SPRINGS RD
LYNCHBURG VA
24501-1109
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-3656
  • Fax: 434-200-3650
Mailing address:
  • Phone: 434-200-3656
  • Fax: 434-200-3650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116030496
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0116030496
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: