Provider Demographics
NPI:1508878448
Name:TYLER, CHERYL LYNN (NP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LYNN
Last Name:TYLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:LYNN
Other - Last Name:GAMMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:218 QUARTERMAN ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-3547
Mailing Address - Country:US
Mailing Address - Phone:912-287-0301
Mailing Address - Fax:912-287-1568
Practice Address - Street 1:122 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:NAHUNTA
Practice Address - State:GA
Practice Address - Zip Code:31553-9806
Practice Address - Country:US
Practice Address - Phone:912-462-6222
Practice Address - Fax:912-287-1568
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN163442363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA349841266AMedicaid
50BBGVWMedicare ID - Type Unspecified
R81691Medicare UPIN