Provider Demographics
NPI:1548960651
Name:SUMNER, TYLER OLIVIA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TYLER
Middle Name:OLIVIA
Last Name:SUMNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:TYLER
Other - Middle Name:OLIVIA
Other - Last Name:SCOGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 746450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6450
Mailing Address - Country:US
Mailing Address - Phone:866-401-3057
Mailing Address - Fax:318-868-6430
Practice Address - Street 1:1700 CENTER ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3301
Practice Address - Country:US
Practice Address - Phone:251-415-1000
Practice Address - Fax:251-415-1001
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2346363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant