Provider Demographics
NPI:1366865594
Name:HALVAKSZ, TYLER (APRN)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:HALVAKSZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 NICHOLASVILLE RD
Mailing Address - Street 2:STE. 702
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1404
Mailing Address - Country:US
Mailing Address - Phone:859-264-8811
Mailing Address - Fax:859-264-8822
Practice Address - Street 1:1720 NICHOLASVILLE RD
Practice Address - Street 2:STE. 702
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1404
Practice Address - Country:US
Practice Address - Phone:859-264-8811
Practice Address - Fax:859-264-8822
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008474363LX0001X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100281300Medicaid
KYK115380Medicare PIN