Provider Demographics
NPI:1952666158
Name:NIGUS, TYLER JACKSON
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JACKSON
Last Name:NIGUS
Suffix:
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 1:7295 W 97TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-2209
Mailing Address - Country:US
Mailing Address - Phone:913-953-5959
Mailing Address - Fax:913-953-5959
Practice Address - Street 1:6604 W 91ST ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-6003
Practice Address - Country:US
Practice Address - Phone:816-812-7080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program