Provider Demographics
NPI:1457343956
Name:TYSON, COURTNEY E (PA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:E
Last Name:TYSON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:125 WEST IH-30
Mailing Address - Street 2:SUITE L
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189
Mailing Address - Country:US
Mailing Address - Phone:972-635-9490
Mailing Address - Fax:972-635-2190
Practice Address - Street 1:4211 JOE RAMSEY BLVD E
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7852
Practice Address - Country:US
Practice Address - Phone:903-408-7700
Practice Address - Fax:903-408-7810
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2022-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA04299363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J629OtherMEDICARE GROUP