Provider Demographics
NPI:1881143402
Name:TYLER, MATTHEW (FNP-BC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:TYLER
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24B CAMDEN BYP
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AL
Mailing Address - Zip Code:36726-1770
Mailing Address - Country:US
Mailing Address - Phone:334-882-1919
Mailing Address - Fax:
Practice Address - Street 1:218 MAIN STREET
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:AL
Practice Address - Zip Code:36446-0065
Practice Address - Country:US
Practice Address - Phone:334-636-4823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-130779363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner