Provider Demographics
NPI:1619240835
Name:JENNINGS, TYLER JOBETH
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JOBETH
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 HEIDI CIR
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-9514
Mailing Address - Country:US
Mailing Address - Phone:775-830-2053
Mailing Address - Fax:
Practice Address - Street 1:210 HEIDI CIR
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-9514
Practice Address - Country:US
Practice Address - Phone:775-830-2053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-18
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner