Tyra Chisolm
Individual provider Active NPI Personal Care Attendant · South Charleston, WV
NPI 1245917822 · NPPES record last updated Jul 5, 2023
Key facts
- NPI
- 1245917822
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Personal Care Attendant 3747P1801X
- Practice address
- 325 4TH Ave Ste 2
South Charleston, WV 25303-1266 - Phone
- (304) 744-5085
- NPI assigned
- Jul 5, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Personal Care Attendant | 3747P1801X | Yes |
Addresses
Primary practice location
325 4TH Ave Ste 2
South Charleston, WV 25303-1266
Mailing address
325 4TH Ave Ste 2
South Charleston, WV 25303-1266
Phone (304) 744-5085
Other providers in South Charleston, WV
- Janija Marih Chase
- Jakayla Chic
- Clark Edwin Childers Jr.
- Erin Childers
- Christina Chism
- Aaron Lee Christian
- Allison Christian
- Cynthia Christian
- Jeremiah Christian
- Kimberly Elaine Christian
All providers in South Charleston, WV · Personal Care Attendant in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 5, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.