Provider Demographics
NPI:1043768088
Name:GREENWOOD, TYLER JOSHUA (PA)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JOSHUA
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:211 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5049
Practice Address - Country:US
Practice Address - Phone:573-331-5330
Practice Address - Fax:573-331-5025
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2023-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2016034126363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant