Basic Information
| Provider Information | |||||||||
| NPI: | 1225310881 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TYNER | ||||||||
| FirstName: | BELINDA | ||||||||
| MiddleName: | DEONE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1226 OLD CLARK RD | ||||||||
| Address2: | |||||||||
| City: | CEDAR HILL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751045414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2144004876 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1301 W 7TH ST | ||||||||
| Address2: | SUITE 121 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761022651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173480425 | ||||||||
| FaxNumber: | 8173480455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2011 | ||||||||
| LastUpdateDate: | 11/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 794418 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363L00000X | 794418 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.