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NPI Code Detail

MEDICARE: CHANCE ROBERTSON TYLER APRN

MEDICARE: CHANCE ROBERTSON TYLER APRN
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 Practitioner3010206KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811348204
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANCE ROBERTSON TYLER APRN
Provider Business Mailing Address
First Line : 615 ELSINORE PL STE 200
Second Line :
City : CINCINNATI
State : OH
Zip : 45202-1457
Country : US
Telephone Number : 513-834-7063
Fax Number :
Provider Business Practice Location Address
First Line : 621 HAPPY VALLEY RD
Second Line :
City : GLASGOW
State : KY
Zip : 42141-1541
Country : US
Telephone Number : 513-834-7063
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2016
Last Update Date : 03/18/2021

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