Provider Demographics
NPI:1518598838
Name:MYLER, ANDREW (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MYLER
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 LYLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN MOUND
Mailing Address - State:TN
Mailing Address - Zip Code:37079-9443
Mailing Address - Country:US
Mailing Address - Phone:719-330-8728
Mailing Address - Fax:270-412-6802
Practice Address - Street 1:4225 LYLEWOOD RD
Practice Address - Street 2:
Practice Address - City:INDIAN MOUND
Practice Address - State:TN
Practice Address - Zip Code:37079-9443
Practice Address - Country:US
Practice Address - Phone:719-330-8728
Practice Address - Fax:270-412-6802
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171000000XOther Service ProvidersMilitary Health Care Provider