Provider Demographics
NPI:1477399202
Name:MACDONALD, TYLER DENNIS
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:DENNIS
Last Name:MACDONALD
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 1:1 LOUIE B NUNN DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41099-9992
Mailing Address - Country:US
Mailing Address - Phone:859-992-8278
Mailing Address - Fax:
Practice Address - Street 1:1 LOUIE B NUNN DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41099-9992
Practice Address - Country:US
Practice Address - Phone:859-992-8278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program