Provider Demographics
NPI:1093460354
Name:KERN, TYLER WILLIAM
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:WILLIAM
Last Name:KERN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 N DURANGO DR STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-3939
Mailing Address - Country:US
Mailing Address - Phone:702-577-2606
Mailing Address - Fax:702-710-6023
Practice Address - Street 1:6200 N DURANGO DR STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3939
Practice Address - Country:US
Practice Address - Phone:702-577-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician