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General NPI Number Information
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NPI Number | 1013871714
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE COLLECTIVE, PLLC
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Dates
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Enumeration Date | 12/16/2025
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 11300 ROBERTS BLVD
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City | FORT SMITH
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State | AR
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Zip | 72916-6027
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Country | US
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Telephone | 479-242-5910
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Fax | 479-668-0169
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Provider Business Mailing Address
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Address Line | 11300 ROBERTS BLVD
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City | FORT SMITH
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State | AR
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Zip | 72916-6027
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Country | US
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Telephone | 479-242-5910
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Fax | 479-668-0169
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DELLI RAE TYLER
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Credential | DO
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Telephone | 479-883-0917
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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