Provider Demographics
NPI:1083130850
Name:MCANALLY, TYLER DYLAN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:DYLAN
Last Name:MCANALLY
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:259 MCANALLY DR
Mailing Address - Street 2:
Mailing Address - City:SAGE
Mailing Address - State:AR
Mailing Address - Zip Code:72573-8858
Mailing Address - Country:US
Mailing Address - Phone:870-291-2153
Mailing Address - Fax:
Practice Address - Street 1:2200 FORT ROOTS DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-1000
Practice Address - Fax:501-257-2693
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
MEPAN1744363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical