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General NPI Number Information
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NPI Number | 1710583596
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Entity Type | Individual
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Provider Name | RYAN MARTIN TYNER PA
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Gender | Male
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 6799 GREAT OAKS RD STE 100
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City | MEMPHIS
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State | TN
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Zip | 38138-2571
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Country | US
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Telephone | 901-751-0405
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Fax |
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Provider Business Mailing Address
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Address Line | 3838 CENTER HILL CV
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-8713
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Country | US
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Telephone | 901-605-6859
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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 |
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License Number State |
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