Provider Demographics
NPI:1386718229
Name:TYRER, LYNN WHITNEY (PA-C)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:WHITNEY
Last Name:TYRER
Suffix:
Gender:F
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:PO BOX 226
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-0226
Mailing Address - Country:US
Mailing Address - Phone:812-932-5105
Mailing Address - Fax:
Practice Address - Street 1:1051 STATE ROAD 229
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-6809
Practice Address - Country:US
Practice Address - Phone:812-932-5105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000838A363A00000X
OH50.001763363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300011478Medicaid
IN10000838AOtherIN STATE LICENSE