Provider Demographics
NPI:1508436007
Name:PIERSON, TYLER EDWARD (CRNA)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:EDWARD
Last Name:PIERSON
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 1:8667 S U S 231
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-8897
Mailing Address - Country:US
Mailing Address - Phone:334-803-2655
Mailing Address - Fax:
Practice Address - Street 1:8667 S U S 231
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-8897
Practice Address - Country:US
Practice Address - Phone:334-803-2655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL143403367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered