Provider Demographics
NPI:1437410446
Name:TYLER, MEOSHA
Entity type:Individual
Prefix:
First Name:MEOSHA
Middle Name:
Last Name:TYLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MEOSHA
Other - Middle Name:
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3715 N OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-3404
Mailing Address - Country:US
Mailing Address - Phone:316-942-4519
Mailing Address - Fax:316-942-4655
Practice Address - Street 1:3715 N OLIVER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-3404
Practice Address - Country:US
Practice Address - Phone:316-942-4519
Practice Address - Fax:316-942-4655
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1501532363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical