Provider Demographics
NPI:1013491141
Name:WOODS, TYLER
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:WOODS
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 1:1029 W 88TH ST S
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-3473
Mailing Address - Country:US
Mailing Address - Phone:214-886-5020
Mailing Address - Fax:
Practice Address - Street 1:3219 S 79TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1343
Practice Address - Country:US
Practice Address - Phone:918-663-8183
Practice Address - Fax:918-660-5398
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2022-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK113279363LF0000X
OKR0113279363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner