Provider Demographics
NPI:1760098024
Name:PARKER, TYLER SR
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:
Last Name:PARKER
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4879
Mailing Address - Country:US
Mailing Address - Phone:740-475-9376
Mailing Address - Fax:
Practice Address - Street 1:949 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4879
Practice Address - Country:US
Practice Address - Phone:740-475-9376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker