Randall, Tyler William

Randall, Tyler William is an sole proprietor health care provider with primary practice located at 1338 Phay Ave , Canon City CO 81212-2311. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is his primary health care specialty. Randall, Tyler William can be contacted via phone (719) 285-2000.

Contact Information

Primary practice address
1338 Phay Ave Canon City CO 81212-2311
Phone: (719) 285-2000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X AP61177225 Washington
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X AP61177225 Washington
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X APN.0994692-NP Colorado

Profile Details

NPI number 1780241794
LBN Legal business name Randall, Tyler William
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 24th, 2019
Last updated Jun 19th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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