Provider Demographics
NPI:1376788752
Name:KEARNEY, TYLER PAUL (DPM)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:PAUL
Last Name:KEARNEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3312 LONGMIRE DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5812
Mailing Address - Country:US
Mailing Address - Phone:979-776-6060
Mailing Address - Fax:979-776-6172
Practice Address - Street 1:3312 LONGMIRE DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5812
Practice Address - Country:US
Practice Address - Phone:979-776-6060
Practice Address - Fax:979-776-6172
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT33-2008213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01002151OtherRAIL ROAD MEDICARE
TX00613KMedicare Oscar/Certification
TX0314130001Medicare NSC
TXTXB138366Medicare PIN
TXP01002151OtherRAIL ROAD MEDICARE