Individual
MR. ROY NANDO TYLER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CSA
Contact information
Practice address
1945 SCOTTSVILLE RD, B2 PMB 137, BOWLING GREEN, KY 42104-3376
(270) 782-0434
Mailing address
1945 SCOTTSVILLE RD, B2 PMB 137, BOWLING GREEN, KY 42104-3376
(270) 782-0434
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
SA066
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000212655
ANTHEM
KY
01
—
58221859-C
HUMANA
KY
Enumeration date
06/24/2006
Last updated
07/08/2007
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