Provider Demographics
NPI:1952534471
Name:MYERS, TIMOTHY DAVID (LPN)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DAVID
Last Name:MYERS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2641 SYMPHONY WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-3312
Mailing Address - Country:US
Mailing Address - Phone:937-241-4847
Mailing Address - Fax:
Practice Address - Street 1:2641 SYMPHONY WAY
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-3312
Practice Address - Country:US
Practice Address - Phone:937-241-4847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 135128164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse