Provider Demographics
NPI:1578277646
Name:MILLER, TYLER BARTHOLOMEW (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:BARTHOLOMEW
Last Name:MILLER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:337-470-3260
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:2445 E MILTON AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5346
Practice Address - Country:US
Practice Address - Phone:337-470-3260
Practice Address - Fax:337-856-6388
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA229151363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily