Provider Demographics
NPI:1386488971
Name:PATTEN, TYLER D (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:D
Last Name:PATTEN
Suffix:
Gender:M
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2642 E 3380 S
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6203
Mailing Address - Country:US
Mailing Address - Phone:435-272-7022
Mailing Address - Fax:
Practice Address - Street 1:1664 S DIXIE DR STE E102
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7329
Practice Address - Country:US
Practice Address - Phone:435-703-9647
Practice Address - Fax:435-703-6003
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11058933-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health