Provider Demographics
NPI:1619427390
Name:ANDERSON, TYSON RUNAKO (MPH, MSN, AGNP-C)
Entity Type:Individual
Prefix:MR
First Name:TYSON
Middle Name:RUNAKO
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MPH, MSN, AGNP-C
Other - Prefix:
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Mailing Address - Street 1:1400 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1502
Mailing Address - Country:US
Mailing Address - Phone:205-930-1530
Mailing Address - Fax:205-930-0243
Practice Address - Street 1:3636 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1646
Practice Address - Country:US
Practice Address - Phone:202-446-1100
Practice Address - Fax:202-204-0806
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DC210126497363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care