Provider Demographics
NPI:1225286222
Name:TYLER, SHAROLYNN K (APN)
Entity Type:Individual
Prefix:
First Name:SHAROLYNN
Middle Name:K
Last Name:TYLER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14805 N OUTER 40 RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-6060
Mailing Address - Country:US
Mailing Address - Phone:888-811-4677
Mailing Address - Fax:800-605-8906
Practice Address - Street 1:14805 N OUTER 40 RD
Practice Address - Street 2:SUITE 320
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-6060
Practice Address - Country:US
Practice Address - Phone:888-811-4677
Practice Address - Fax:800-605-8906
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK53554Medicare PIN
ILK53551Medicare PIN
ILK53553Medicare PIN
ILK53552Medicare PIN