Basic Information
| Provider Information | |||||||||
| NPI: | 1457471617 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TYNER | ||||||||
| FirstName: | TARYN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1871 SAVAGE RD | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294074726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437666308 | ||||||||
| FaxNumber: | 8438049883 | ||||||||
| Practice Location | |||||||||
| Address1: | 1871 SAVAGE RD | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294074726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437666308 | ||||||||
| FaxNumber: | 8438049883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 02/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 28631 | SC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 286318 | 05 | SC | MEDICAID |