Individual
TYLER B SIMONTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
222 W MICHIGAN ST, INDIANAPOLIS, IN 46204-1254
(317) 779-0303
(317) 737-2149
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003593A
IN
363A00000X
Physician Assistant
12953
GA
363A00000X
Physician Assistant
C0006830
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1740772250
ANTHEM PTAN
IN
05
—
300069733
—
IN
01
—
Q00450054
RAILROAD PTAN
IN
Enumeration date
05/31/2018
Last updated
04/17/2025
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