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General NPI Number Information
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NPI Number | 1073041505
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Entity Type | Individual
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Provider Name | TYLER KEENUM CRNP
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Gender | Male
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Dates
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Enumeration Date | 05/29/2017
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 2703 7TH ST
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City | TUSCALOOSA
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State | AL
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Zip | 35401-1865
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Country | US
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Telephone | 205-759-8470
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Fax | 205-366-9001
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Provider Business Mailing Address
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Address Line | 2703 7TH ST
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City | TUSCALOOSA
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State | AL
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Zip | 35401-1865
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Country | US
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Telephone | 205-759-8470
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Fax | 205-366-9001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1-142399
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License Number State | AL
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