Basic Information
Provider Information | |||||||||
NPI: | 1184010878 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TYRIE | ||||||||
FirstName: | KAITLYN | ||||||||
MiddleName: | NOEL | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SNYDER | ||||||||
OtherFirstName: | KAITLYN | ||||||||
OtherMiddleName: | NOEL | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1 HOSPITAL DR STE 306 | ||||||||
Address2: |   | ||||||||
City: | LEWISBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 178379350 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5705224110 | ||||||||
FaxNumber: | 5707683911 | ||||||||
Practice Location | |||||||||
Address1: | 3 HOSPITAL DR STE 312 | ||||||||
Address2: |   | ||||||||
City: | LEWISBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 17837 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5705238700 | ||||||||
FaxNumber: | 5705238705 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/09/2015 | ||||||||
LastUpdateDate: | 06/08/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/08/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 209311 | NC | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
No ID Information.