MEDICARE: ARIEUNA TYLER

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	343900000X	Non-emergency Medical Transport (VAN)
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1144078692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIEUNA TYLER

Provider Business Mailing Address
First Line	:	10728 JIMMY LAKE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-1259
Country	:	US
Telephone Number	:	317-506-1158
Fax Number	:

Provider Business Practice Location Address
First Line	:	1940 FOUNTAIN VIEW DR # 3056
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-3206
Country	:	US
Telephone Number	:	317-506-1158
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2024
Last Update Date	:	05/09/2024

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