Provider Demographics
NPI:1285454967
Name:POE, TYLER PERRY (CRNP)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:PERRY
Last Name:POE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 HIGHWAY 69 S STE C
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-8784
Mailing Address - Country:US
Mailing Address - Phone:205-349-1040
Mailing Address - Fax:
Practice Address - Street 1:7700 HIGHWAY 69 S STE C
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-8784
Practice Address - Country:US
Practice Address - Phone:205-349-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-184764363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily