Individual
TYLER JOHN HALSTEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4111 1ST AVE STE 3, NITRO, WV 25143-1345
(304) 755-4797
(304) 755-4799
Mailing address
4111 1ST AVE STE 3, NITRO, WV 25143-1345
(304) 755-4797
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
826
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730725151
—
WV
Enumeration date
11/20/2019
Last updated
03/30/2026
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