Individual
LEA ANN TYLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
931 E 32ND ST, JOPLIN, MO 64804-2878
(417) 347-4374
Mailing address
PO BOX 3810, JOPLIN, MO 64803-3810
(417) 347-4374
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2012039527
MO
363LA2200X
Adult Health Nurse Practitioner
2012039527
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710267539
—
MO
05
—
201011590A
—
KS
Enumeration date
08/24/2011
Last updated
03/31/2017
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