Individual
COURTNEY E. TYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
4211 JOE RAMSEY BLVD E, SUITE 100, GREENVILLE, TX 75401-7852
(903) 408-7700
(903) 408-7810
Mailing address
125 WEST IH-30, SUITE L, ROYSE CITY, TX 75189
(972) 635-9490
(972) 635-2190
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA04299
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00J629
MEDICARE GROUP
TX
Enumeration date
08/19/2005
Last updated
04/12/2022
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