Provider Demographics
NPI:1508090630
Name:COREY, TYLER MASON (MD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:MASON
Last Name:COREY
Suffix:
Gender:M
Credentials:MD
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 910530
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-0530
Mailing Address - Country:US
Mailing Address - Phone:877-783-6257
Mailing Address - Fax:859-514-5521
Practice Address - Street 1:913 N DIXIE AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2503
Practice Address - Country:US
Practice Address - Phone:877-783-6257
Practice Address - Fax:859-514-5521
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45495207P00000X
KYR2162390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100135150Medicaid
KYK023591OtherMEDICARE PTAN- NICC