Provider Demographics
NPI:1720873144
Name:BROWN, TYLER LAMAR
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:LAMAR
Last Name:BROWN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 CASCADE AVE UNIT 4305
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8710
Mailing Address - Country:US
Mailing Address - Phone:208-419-7466
Mailing Address - Fax:
Practice Address - Street 1:8025 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5360
Practice Address - Country:US
Practice Address - Phone:515-271-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program