Provider Demographics
NPI:1871168443
Name:MCBETH, TYLER MATTHEW (DNP, FNP)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:MATTHEW
Last Name:MCBETH
Suffix:
Gender:M
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 WESTCHESTER AVE STE G03
Mailing Address - Street 2:
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2580
Mailing Address - Country:US
Mailing Address - Phone:914-997-4100
Mailing Address - Fax:
Practice Address - Street 1:2975 WESTCHESTER AVE STE G03
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2580
Practice Address - Country:US
Practice Address - Phone:914-997-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY744942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY744942Medicaid