MEDICARE: TYLER ANDERSON

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	363LP2300X	Primary Care Nurse Practitioner	97257104405	UT

General Provider Information

NPI Number	:	1871359398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER ANDERSON

Provider Business Mailing Address
First Line	:	1443 S PEBBLECREEK DR
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-8111
Country	:	US
Telephone Number	:	801-326-9001
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 CHAMBERS ST STE 200
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-4519
Country	:	US
Telephone Number	:	801-627-2122
Fax Number	:

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

Provider Enumeration Date	:	02/22/2024
Last Update Date	:	02/22/2024

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Directions to “ TYLER ANDERSON ” Practice Location

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