Provider Demographics
NPI:1316551526
Name:WILLIAMS, TYLAR ALEXIS (APRN)
Entity type:Individual
Prefix:
First Name:TYLAR
Middle Name:ALEXIS
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-559-9423
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:2949 BRECKENRIDGE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1408
Practice Address - Country:US
Practice Address - Phone:502-446-5555
Practice Address - Fax:502-638-3391
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3014034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300093701Medicaid
KY7100698440Medicaid