Tyler Roberts, PA-C
Physician Assistant in Lugoff, SC. Individual provider (NPI-1).
NPI number1164033353
StatusActive
Last updated in NPPESMay 2, 2023
Details
- NPI
- 1164033353
- Entity type
- Individual (NPI-1)
- Name
- Tyler Roberts
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 12, 2020
- Certification date
- May 2, 2023
- Last updated
- May 2, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | – | – | Yes |
| 363A00000X | Physician Assistant | 4796 | SC |
Practice location
15 Exchange DrLugoff, SC 29078-9198
Phone 803-670-8238
Mailing address
15 Exchange DrLugoff, SC 29078-9198
Phone 803-670-8238
Other practice locations
Private
Louisville, KY 40241
Louisville, KY 40241
Phone 502-322-7192
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