Provider Demographics
NPI:1689241069
Name:BYLER, MATTIE A (LCPM)
Entity Type:Individual
Prefix:
First Name:MATTIE
Middle Name:A
Last Name:BYLER
Suffix:
Gender:F
Credentials:LCPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 KY HIGHWAY 643
Mailing Address - Street 2:
Mailing Address - City:CRAB ORCHARD
Mailing Address - State:KY
Mailing Address - Zip Code:40419-8936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6820 KY HIGHWAY 643
Practice Address - Street 2:
Practice Address - City:CRAB ORCHARD
Practice Address - State:KY
Practice Address - Zip Code:40419-8936
Practice Address - Country:US
Practice Address - Phone:859-749-5845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-05
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9000025176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty