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General NPI Number Information
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NPI Number | 1356584056
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Entity Type | Individual
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Provider Name | TERRA N. TYLER M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 10/05/2014
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Provider Practice Location Address
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Address Line | 1380 RIVER BEND DR
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City | DALLAS
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State | TX
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Zip | 75247-4914
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Country | US
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Telephone | 972-861-5625
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Fax |
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Provider Business Mailing Address
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Address Line | 12287 SALT GRASS LN
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City | FRISCO
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State | TX
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Zip | 75035-2262
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Country | US
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Telephone | 501-352-6085
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | P9757
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 45386
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License Number State | KY
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