Provider Demographics
NPI:1003674946
Name:WHITE, TYLER LEE (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:LEE
Last Name:WHITE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6402 ASBELL RD
Mailing Address - Street 2:
Mailing Address - City:SHOALS
Mailing Address - State:IN
Mailing Address - Zip Code:47581-7839
Mailing Address - Country:US
Mailing Address - Phone:812-296-8238
Mailing Address - Fax:
Practice Address - Street 1:3 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-2907
Practice Address - Country:US
Practice Address - Phone:812-486-6639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015039A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily