Provider Demographics
NPI:1164169686
Name:HARLESS, TYLER MCKAYLEN (DO)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:MCKAYLEN
Last Name:HARLESS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 FULLER RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39309-5106
Mailing Address - Country:US
Mailing Address - Phone:601-679-2208
Mailing Address - Fax:
Practice Address - Street 1:1801 FULLER RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39309-2111
Practice Address - Country:US
Practice Address - Phone:601-679-2208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS32459208D00000X
171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice