Wade, Tyra

Wade, Tyra is an individual health care provider with primary practice located at 4780 I 55 N Ste 105 , Jackson MS 39211-5542. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Other Service Providers / Case Manager/Care Coordinator. Other Service Providers / Case Manager/Care Coordinator is her primary health care specialty. Wade, Tyra can be contacted via phone (601) 956-4816.

Contact Information

Primary practice address
4780 I 55 N Ste 105 Jackson MS 39211-5542
Phone: (601) 956-4816
Fax: (601) 956-4817
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Other Service Providers / Case Manager/Care Coordinator 171M00000X

Profile Details

NPI number 1477735769
LBN Legal business name Wade, Tyra
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 29th, 2007
Last updated Mar 10th, 2022 - 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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Identifiers

StateTypeNumberIssuer
All States NPI 1477735769 NPPES
Mississippi MEDICAID 01670076

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