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General NPI Number Information
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NPI Number | 1649423278
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Entity Type | Individual
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Provider Name | TYLER NICHOLAS CARRUTH P.A.
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Gender | Male
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 8742 GOODWOOD BLVD
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City | BATON ROUGE
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State | LA
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Zip | 70806-7915
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Country | US
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Telephone | 225-893-0810
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 44158
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City | BATON ROUGE
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State | LA
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Zip | 70804-4158
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Country | US
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Telephone | 281-787-4362
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.A10424
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA03418
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License Number State | TX
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