Provider Demographics
NPI:1487114310
Name:MILLER, TYLER JOSEPH (MSN)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:JOSEPH
Last Name:MILLER
Suffix:
Gender:M
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 NORTHERN HILLS LN
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-4158
Mailing Address - Country:US
Mailing Address - Phone:605-641-4890
Mailing Address - Fax:
Practice Address - Street 1:1440 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1505
Practice Address - Country:US
Practice Address - Phone:605-644-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCR001016367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered