Healthcare Provider Details

I. General information

NPI: 1275401333
Provider Name (Legal Business Name): TYRA HOARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 3 MILE RD
RACINE WI
53402-2901
US

IV. Provider business mailing address

7221 W WABASH AVE
MILWAUKEE WI
53223-2608
US

V. Phone/Fax

Practice location:
  • Phone: 863-308-1318
  • Fax:
Mailing address:
  • Phone: 262-402-8615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number325278
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: