Provider Demographics
NPI:1477388031
Name:PATTON, TYLER ELLIS
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:ELLIS
Last Name:PATTON
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 1:1880 AMHERST ST STE 100AND
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2900
Mailing Address - Country:US
Mailing Address - Phone:540-662-0306
Mailing Address - Fax:855-264-2066
Practice Address - Street 1:1880 AMHERST ST STE 100
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2917
Practice Address - Country:US
Practice Address - Phone:540-662-0306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110010518363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant