Provider Demographics
NPI:1841525060
Name:MILLER-BOST, TYLER (FNP)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:MILLER-BOST
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 1:1811 E INNES ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-6030
Mailing Address - Country:US
Mailing Address - Phone:704-216-8832
Mailing Address - Fax:704-638-3129
Practice Address - Street 1:1811 E INNES ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-6030
Practice Address - Country:US
Practice Address - Phone:704-216-8832
Practice Address - Fax:704-638-3129
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005022Medicaid
NC2594583AOtherMEDICARE PTAN INDIVIDUAL ROWAN
NC2335816OtherMEDICARE PTAN, GROUP WILKES
NC0723LOtherBLUECROSSBLUESHIELD OF NC
NCNC2161AOtherMEDICARE PTAN INDIVIDUAL WILKES
NC3404380Medicaid