MEDICARE: PRIMARY CARE COLLECTIVE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1013871714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE COLLECTIVE, PLLC

Provider Business Mailing Address
First Line	:	11300 ROBERTS BLVD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-6027
Country	:	US
Telephone Number	:	479-242-5910
Fax Number	:	479-668-0169

Provider Business Practice Location Address
First Line	:	11300 ROBERTS BLVD
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-6027
Country	:	US
Telephone Number	:	479-242-5910
Fax Number	:	479-668-0169

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. DELLI RAE TYLER
Credential	:	DO
Telephone Number	:	479-883-0917

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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