Provider Demographics
NPI:1013709054
Name:TYLER HUNT PMHNP-BC LLC
Entity type:Organization
Organization Name:TYLER HUNT PMHNP-BC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:865-804-1217
Mailing Address - Street 1:2328 PORTLAND DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-8306
Mailing Address - Country:US
Mailing Address - Phone:865-804-1217
Mailing Address - Fax:
Practice Address - Street 1:3787 RIVER RD N STE A
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4899
Practice Address - Country:US
Practice Address - Phone:865-804-1217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-17
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500845613Medicaid