Provider Demographics
NPI:1295381010
Name:AYRES, MACY (CPNP-PC)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:
Last Name:AYRES
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:MACY
Other - Middle Name:
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:523 S FANNIN AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8204
Mailing Address - Country:US
Mailing Address - Phone:903-535-9041
Mailing Address - Fax:903-531-9490
Practice Address - Street 1:2990 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-2149
Practice Address - Country:US
Practice Address - Phone:903-535-9041
Practice Address - Fax:903-592-3886
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142764363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics