Provider Demographics
NPI:1558372011
Name:PYSELL, TIMOTHY A (PA-C)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:PYSELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 ADLEY WAY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6511
Mailing Address - Country:US
Mailing Address - Phone:864-203-5715
Mailing Address - Fax:
Practice Address - Street 1:242 ADLEY WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6511
Practice Address - Country:US
Practice Address - Phone:864-203-5715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3104363A00000X
SC2821363A00000X
NC0010-04439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCE469AMedicare PIN
NCNCE469AMedicare PIN