MEDICARE: MS. MITZIE JO TYREE

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	171M00000X	Case Manager/Care Coordinator		KS

General Provider Information

NPI Number	:	1306723622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MITZIE JO TYREE

Provider Business Mailing Address
First Line	:	636 SW GRANDVIEW AVE
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66606-1817
Country	:	US
Telephone Number	:	785-925-5724
Fax Number	:	785-925-5724

Provider Business Practice Location Address
First Line	:	636 SW GRANDVIEW AVE
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66606-1817
Country	:	US
Telephone Number	:	785-925-5724
Fax Number	:	785-925-5724

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

Provider Enumeration Date	:	08/19/2025
Last Update Date	:	08/19/2025

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