Basic Information
| Provider Information | |||||||||
| NPI: | 1376776195 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TYLER | ||||||||
| FirstName: | MEAGAN | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1516S YORKTOWN PL | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741044918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187128888 | ||||||||
| FaxNumber: | 9187128892 | ||||||||
| Practice Location | |||||||||
| Address1: | 6475 S YALE AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741367816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184949300 | ||||||||
| FaxNumber: | 9184949324 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2009 | ||||||||
| LastUpdateDate: | 09/11/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | 1921 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 200294680A | 05 | OK | MEDICAID |