Provider Demographics
NPI:1760089585
Name:KYLER, TANYA MILLICENT (FIELD MEDICAL MA)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:MILLICENT
Last Name:KYLER
Suffix:
Gender:F
Credentials:FIELD MEDICAL MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20521
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44701-0521
Mailing Address - Country:US
Mailing Address - Phone:234-410-4175
Mailing Address - Fax:
Practice Address - Street 1:512 SHORB AVE NW APT 3
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-2580
Practice Address - Country:US
Practice Address - Phone:234-410-4175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE4UO-N515-GC9C208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice