Provider Demographics
NPI:1376776195
Name:TYLER, MEAGAN (PA)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516S YORKTOWN PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4918
Mailing Address - Country:US
Mailing Address - Phone:918-712-8888
Mailing Address - Fax:918-712-8892
Practice Address - Street 1:6475 S YALE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7816
Practice Address - Country:US
Practice Address - Phone:918-494-9300
Practice Address - Fax:918-494-9324
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
OK1921363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200294680AMedicaid