# MRS. STEPHANIE E. TYSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1437683224
- **Gender:** F
- **Credential:** NP-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | RN200512 | GA | Yes |

## Other

- **Enumeration date:** 04/18/2017
- **Last updated:** 09/01/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 003203586A | — | GA |
| 01 | — | G04354A | MEDICARE PTAN | GA |