Provider Demographics
NPI:1306498068
Name:WARBRITTON, TYLER S (PA-C)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:S
Last Name:WARBRITTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3493 VETERANS DR N STE C
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344-6230
Mailing Address - Country:US
Mailing Address - Phone:731-986-2933
Mailing Address - Fax:731-986-2938
Practice Address - Street 1:3493 VETERANS DR N STE C
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344-6230
Practice Address - Country:US
Practice Address - Phone:731-986-2933
Practice Address - Fax:731-986-2938
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3905207Q00000X
TNPA3905363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ054966Medicaid
TN1523966Medicaid