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NPI Code Detail

MEDICARE: TYLER TERRY NP

MEDICARE: TYLER TERRY NP
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
1363LF0000XFamily Nurse Practitioner5011884NC
2208VP0000XPain Medicine Physician5011884NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15011884OTHERNCNC MEDICAL BOARD

General Provider Information

NPI Number : 1467012054
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLER TERRY NP
Provider Business Mailing Address
First Line : 645 N MAIN ST
Second Line :
City : HIGH POINT
State : NC
Zip : 27260-5017
Country : US
Telephone Number : 336-883-0029
Fax Number : 336-883-0867
Provider Business Practice Location Address
First Line : 3402 BATTLEGROUND AVE
Second Line :
City : GREENSBORO
State : NC
Zip : 27410-2578
Country : US
Telephone Number : 336-883-0029
Fax Number : 336-883-0867
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2019
Last Update Date : 04/22/2022

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