Provider Demographics
NPI:1043313166
Name:HOWARD, TYLER R (PA-C)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:R
Last Name:HOWARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 BUFORD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3422
Mailing Address - Country:US
Mailing Address - Phone:804-272-8806
Mailing Address - Fax:804-272-2909
Practice Address - Street 1:2602 BUFORD RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-3422
Practice Address - Country:US
Practice Address - Phone:804-272-8806
Practice Address - Fax:804-272-2909
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA110001618363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MH0927624Medicare UPIN