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General NPI Number Information
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NPI Number | 1760056139
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Entity Type | Individual
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Provider Name | CHASTITY TYLER RN
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Gender | Female
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 1126 US HWY BUS S STE A
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City | WINNSBORO
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State | SC
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Zip | 29180
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Country | US
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Telephone | 800-881-5101
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Fax |
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Provider Business Mailing Address
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Address Line | 1017 FULMER RD
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-9085
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Country | US
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Telephone | 803-269-7595
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 256194
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License Number State | SC
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