Provider Demographics
NPI:1306814546
Name:NELSON, TYLER J (MD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:J
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1615
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-1615
Mailing Address - Country:US
Mailing Address - Phone:501-776-6093
Mailing Address - Fax:501-776-6019
Practice Address - Street 1:319 BRYANT AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-3815
Practice Address - Country:US
Practice Address - Phone:501-653-0353
Practice Address - Fax:501-653-0347
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4284207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157559001Medicaid
AR157559001Medicaid
AR5N272Medicare ID - Type Unspecified