Provider Demographics
NPI:1467429092
Name:TYLER, JAMES (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:TYLER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 SAINT JOHNS BLVD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1563
Mailing Address - Country:US
Mailing Address - Phone:417-781-2727
Mailing Address - Fax:417-625-2279
Practice Address - Street 1:2817 SAINT JOHNS BLVD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1563
Practice Address - Country:US
Practice Address - Phone:417-781-2727
Practice Address - Fax:417-625-2279
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO085084367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO916872310Medicaid
KS100250310CMedicaid
OK100786690BMedicaid
KS100250310CMedicaid