Wallace, Tyler J
Wallace, Tyler J is an sole proprietor health care provider with primary practice located at 4570 Pecan Dr Ste C , Paducah KY 42001-6717. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as his primary health care specialty. Wallace, Tyler J can be contacted via phone (270) 908-3839.Contact Information
Primary practice address
4570 Pecan Dr Ste C
Paducah KY 42001-6717
Phone: (270) 908-3839
Fax: (270) 908-3834
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health | 363LP0808X | 4005513 | Kentucky |
Profile Details
| NPI number | 1114700739 |
|---|---|
| LBN Legal business name | Wallace, Tyler J |
| Credentials | PMHNP-BC |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 16th, 2023 |
| Last updated | Aug 16th, 2023 - about last year |
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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