MR. TYLER ALAN PETERSON (NPI# 1467800243) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467800243 |
| Entity Type | Individual |
| Full Name | MR. TYLER ALAN PETERSON |
| Credential | D.O. |
| Practice Address |
888 S Rancho Dr Las Vegas NV 89106-3810 |
| Mailing Address |
Po Box 35380 Las Vegas NV 89133-5380 |
| Practice Telephone | 7028775199 |
| Mailing Telephone | 7025793203 |
| Mailing Fax Number | 7028381456 |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2019-07-11 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | DO2471 | NV | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | SL1157 | NV | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NV | MEDICARE | V58740 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 620 Shadow Lane, Las Vegas, NV 891064194 | 7023888436 | 7023888431 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780042036 | Tyler James Peterson | Chiropractor | 8470 City Centre Dr Ste D, Woodbury, MN 55125-3356 | 2016-02-02 |
| 1306074836 | Tyler Blaine Peterson | Dentist | 625 E. Nicollet Blvd., Suite 340, Burnsville, MN 55337 | 2009-06-23 |
| 1124643960 | Tyler Andrew Peterson | Student in an Organized Health Care Education/Training Program | 1150 N Indian Canyon Dr, Palm Springs, CA 92262-4872 | 2020-06-08 |
| 1093291700 | Tyler Peterson Peterson | Physical Therapy Assistant | 1334 N Whitman Ln Ste 100, Liberty Lake, WA 99019-6034 | 2018-07-16 |
| 1821523184 | Tyler Peterson | Chiropractor | 1302 W 7th St, Wayne, NE 68787-1692 | 2017-04-25 |
| 1639328784 | Tyler Jeffrey Peterson | Internal Medicine | 200 1st St Sw, Rochester, MN 55905-0001 | 2008-09-13 |
| Street Address |
888 S RANCHO DR |
| City | LAS VEGAS |
| State | NV |
| Zip Code | 89106-3810 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497757181 | Todd A Radivan | Physician Assistant | 888 S Rancho Dr, Las Vegas, NV 89106-3810 | 2005-08-11 |
| 1902448855 | James H Smith | Physician Assistant | 888 S Rancho Dr, Las Vegas, NV 89106-3810 | 2019-10-11 |
| 1659913580 | Sarah Kolmer | Physician Assistant | 888 S Rancho Dr, Las Vegas, NV 89106-3810 | 2019-10-11 |
| 1235771197 | Courtney Rae Botelho | Physician Assistant | 888 S Rancho Dr, Las Vegas, NV 89106-3810 | 2019-10-11 |
| 1780143164 | Julie J Hussey | Registered Nurse | 888 S Rancho Dr, Las Vegas, NV 89106-3810 | 2019-03-15 |
| 1376000349 | Amanda Lynette Helton | Nurse Practitioner | 888 S Rancho Dr, Las Vegas, NV 89106-3810 | 2019-02-26 |
| 1720543903 | Natasha Leah Ross | Nurse Practitioner | 888 S Rancho Dr, Las Vegas, NV 89106-3810 | 2019-02-01 |
| 1538650619 | Jennifer H Williams | Nurse Practitioner | 888 S Rancho Dr, Las Vegas, NV 89106-3810 | 2018-05-23 |
| 1033656863 | Nicholas Michael Bryant | Physician Assistant | 888 S Rancho Dr, Las Vegas, NV 89106-3810 | 2017-01-31 |
| 1588024822 | Jerifaye Basiga Flores | Registered Nurse | 888 S Rancho Dr, Las Vegas, NV 89106-3810 | 2016-02-29 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417555772 | Graciela Miranda Cocorpio | Technician | 820 Rancho Ln Suite #40, Las Vegas, NV 89106 | 2020-10-09 |
| 1679101679 | A Better You Wellness Center | Counselor | 320 W Monroe Street, Las Vegas, NV 89106 | 2020-03-27 |
| 1730725177 | Mariah La'neese Jones | Rehabilitation Practitioner | 400 Shadow Lane Ste 106, Las Vegas, NV 89106 | 2019-11-20 |
| 1417592841 | Lourdes Rita Apumayta-paredes | Technician | 820 Rancho Lane, Suite #40, Las Vegas, NV 89106 | 2019-11-08 |
| 1902456551 | Marisela Pena | Technician | 820 Rancho Ln., 25, Las Vegas, NV 89106 | 2019-09-16 |
| 1992368724 | Amber Nicole Mahajan | Nurse Practitioner | 2020 Wellness Way, Suite 300, Las Vegas, NV 89106 | 2019-04-17 |
| 1568924215 | Arlandrea Tarvins | Behavioral Analyst | 1048 Miller Ave, Las Vegas, NV 89106 | 2019-04-02 |
| 1427510361 | Erik Pennell | Student in an Organized Health Care Education/Training Program | 1542 Pinto Ln, 2nd Floor, Las Vegas, NV 89106 | 2019-04-01 |
| 1245702729 | Bruce Mark Babb | Technician | 820 Rancho Lane Ste #40, Las Vegas, NV 89106 | 2018-12-21 |
| 1639649213 | Antonio Ruiz Pelfort | Technician | 1951 Stella Lake St Suite 36, Las Vegas, NV 89106 | 2018-11-27 |
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| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
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| 1629687926 | Maria Habbi Md | Family Medicine | 501 S Rancho Dr Ste F40, Las Vegas, NV 89106-4834 | 2020-07-23 |
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| 1659995090 | Universal Medical Alliance Inc. | Family Medicine | 6268 Spring Mountain Rd Ste 115b, Las Vegas, NV 89146-8873 | 2020-06-02 |
| 1255954640 | Partners In Primary Care Nv PC | Family Medicine | 4919 W Craig Rd, Las Vegas, NV 89130-2730 | 2020-05-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.