Provider Demographics
NPI:1114688827
Name:TYLER, JENNIFER DINKINS (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DINKINS
Last Name:TYLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KEITH
Other - Last Name:DINKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1100 CONLEY RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-7420
Mailing Address - Country:US
Mailing Address - Phone:606-224-6796
Mailing Address - Fax:
Practice Address - Street 1:1914 HIGHWAY 192 W
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1679
Practice Address - Country:US
Practice Address - Phone:859-756-6841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty