Provider Demographics
NPI:1396916722
Name:TYLER, FAITH A (FNP)
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:A
Last Name:TYLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 9
Mailing Address - Street 2:439 ELIZABETH WAY
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25840-9505
Mailing Address - Country:US
Mailing Address - Phone:304-574-2600
Mailing Address - Fax:304-574-2951
Practice Address - Street 1:RR 3 BOX 9
Practice Address - Street 2:439 ELIZABETH WAY
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840-9505
Practice Address - Country:US
Practice Address - Phone:304-574-2600
Practice Address - Fax:304-574-2951
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV61829363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily