# TYLER B SIMONTON

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

## Provider details

- **NPI number:** 1740772250
- **Gender:** F
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 10003593A | IN | Yes |
| 363A00000X | Physician Assistant | 12953 | GA | — |
| 363A00000X | Physician Assistant | C0006830 | MD | — |

## Other

- **Enumeration date:** 05/31/2018
- **Last updated:** 04/17/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1740772250 | ANTHEM PTAN | IN |
| 05 | — | 300069733 | — | IN |
| 01 | — | Q00450054 | RAILROAD PTAN | IN |