Provider Demographics
NPI:1992343511
Name:SHELBY, TYLER ALAN (DNP)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:ALAN
Last Name:SHELBY
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-4884
Mailing Address - Country:US
Mailing Address - Phone:309-224-7720
Mailing Address - Fax:
Practice Address - Street 1:1111 W KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5711
Practice Address - Country:US
Practice Address - Phone:563-468-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA155609207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine