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Individual
HOLLY JEN TYSON
Active
Individual
HOLLY JEN TYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00464
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA00464
STATE ID NO.
TX
05
—
PA00464
—
TX
Enumeration date
02/19/2007
Last updated
07/08/2007
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