Provider Demographics
NPI:1851028682
Name:WILSON, TYLER LEIGH (DNP AGNP)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:LEIGH
Last Name:WILSON
Suffix:
Gender:F
Credentials:DNP AGNP
Other - Prefix:
Other - First Name:TYLER
Other - Middle Name:
Other - Last Name:LAUNHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7880
Mailing Address - Country:US
Mailing Address - Phone:518-761-0300
Mailing Address - Fax:
Practice Address - Street 1:1299 ROUTE 9
Practice Address - Street 2:
Practice Address - City:GANSEVOORT
Practice Address - State:NY
Practice Address - Zip Code:12831-1560
Practice Address - Country:US
Practice Address - Phone:518-761-6961
Practice Address - Fax:518-761-1006
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310983363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07478788Medicaid