Provider Demographics
NPI:1417565904
Name:PHILLIPS, TYLER P (AUD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:P
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2901
Mailing Address - Country:US
Mailing Address - Phone:865-777-1727
Mailing Address - Fax:865-966-0942
Practice Address - Street 1:144 CONCORD RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2901
Practice Address - Country:US
Practice Address - Phone:865-777-1727
Practice Address - Fax:865-966-0942
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1997231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist