Individual
TYRELL WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
102 S INTERSTATE DR STE 18, SIKESTON, MO 63801-8641
(573) 481-5473
Mailing address
102 S INTERSTATE DR STE 18, SIKESTON, MO 63801-8641
(573) 481-5473
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85-3551579
—
MO
Enumeration date
08/17/2021
Last updated
07/19/2023
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