Provider Demographics
NPI:1417786732
Name:DENSMORE, TYLER RAE (APRN)
Entity type:Individual
Prefix:MRS
First Name:TYLER
Middle Name:RAE
Last Name:DENSMORE
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-0334
Mailing Address - Country:US
Mailing Address - Phone:469-471-2454
Mailing Address - Fax:
Practice Address - Street 1:640 N WALNUT AVE
Practice Address - Street 2:STE 1208
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-0334
Practice Address - Country:US
Practice Address - Phone:469-471-2454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1109035363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics