Provider Demographics
NPI:1215392360
Name:PREWETT, TYLER JOHN
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JOHN
Last Name:PREWETT
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 1:220 PAUL ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3225
Mailing Address - Country:US
Mailing Address - Phone:540-421-8101
Mailing Address - Fax:
Practice Address - Street 1:220 PAUL ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3225
Practice Address - Country:US
Practice Address - Phone:540-421-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant