=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770427270
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JABRIA R TYLER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2026
-----------------------------------------------------
Last Update Date | 04/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 RANDALL ST
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39203-1346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-715-2216
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 725 RANDALL ST
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39203-1346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-715-2216
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number | MS012668101702
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------