Provider Demographics
NPI:1144636119
Name:BYERS, GREGARY (NP-C)
Entity type:Individual
Prefix:
First Name:GREGARY
Middle Name:
Last Name:BYERS
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-1822
Mailing Address - Country:US
Mailing Address - Phone:731-212-3196
Mailing Address - Fax:731-212-3193
Practice Address - Street 1:107 TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-1822
Practice Address - Country:US
Practice Address - Phone:731-212-3196
Practice Address - Fax:731-212-3193
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18850363LF0000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ010912Medicaid