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General NPI Number Information
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NPI Number | 1174829915
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Entity Type | Individual
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Provider Name | KEESHA TYLER FNP
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Gender | Female
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Dates
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Enumeration Date | 01/26/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1450 ROSS CLARK CIR STE 400
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City | DOTHAN
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State | AL
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Zip | 36301-4770
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Country | US
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Telephone | 334-305-0400
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Fax | 334-305-0401
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Provider Business Mailing Address
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Address Line | PO BOX 2266
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City | DOTHAN
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State | AL
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Zip | 36302-2266
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Country | US
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Telephone | 334-305-0400
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Fax | 334-305-0401
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-097574
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License Number State | AL
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