Provider Demographics
NPI:1184010878
Name:TYRIE, KAITLYN NOEL (MD)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:NOEL
Last Name:TYRIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KAITLYN
Other - Middle Name:NOEL
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL DR STE 306
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9350
Mailing Address - Country:US
Mailing Address - Phone:570-522-4110
Mailing Address - Fax:570-768-3911
Practice Address - Street 1:3 HOSPITAL DR STE 312
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837
Practice Address - Country:US
Practice Address - Phone:570-523-8700
Practice Address - Fax:570-523-8705
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC209311207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology