MEDICARE: HEATHER FAITH TYER PA-C, MMSC, MPH

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	363A00000X	Physician Assistant	085004618	IL
2	363A00000X	Physician Assistant	PA00259	MS
3	363A00000X	Physician Assistant	4081	SC

General Provider Information

NPI Number	:	1902144629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER FAITH TYER PA-C, MMSC, MPH

Provider Business Mailing Address
First Line	:	735 JOYNER AVE
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38804-2523
Country	:	US
Telephone Number	:	336-207-1479
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 SAINT FRANCIS DR STE 220
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-3976
Country	:	US
Telephone Number	:	864-255-1901
Fax Number	:

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

Provider Enumeration Date	:	01/30/2013
Last Update Date	:	10/03/2024

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