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General NPI Number Information
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NPI Number | 1881130177
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Entity Type | Individual
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Provider Name | TYLER MAXWELL PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/11/2017
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 5838 E CENTRAL AVE
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City | WICHITA
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State | KS
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Zip | 67208-4203
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Country | US
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Telephone | 316-440-4594
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Fax |
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Provider Business Mailing Address
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Address Line | 1947 N FOUNDERS CIR
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City | WICHITA
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State | KS
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Zip | 67206-3548
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Country | US
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Telephone | 162-744-6403
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Fax | 613-274-4704
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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 | 15-02516
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License Number State | KS
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