Provider Demographics
NPI:1225614514
Name:TYSON, CHRISTOPHER (RN)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:TYSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:TYSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:813 E X ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-3727
Mailing Address - Country:US
Mailing Address - Phone:832-788-4463
Mailing Address - Fax:
Practice Address - Street 1:813 E X ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-3727
Practice Address - Country:US
Practice Address - Phone:832-788-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX724655163WH0200X, 163WI0500X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Single Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No163WE0003XNursing Service ProvidersRegistered NurseEmergencyGroup - Single Specialty