Individual provider Active NPI

Mary Jane Tyler, RN, ARNP

  • Registered Nurse
  • Mount Vernon, WA
National Provider Identifier
1306889811
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
RN00065198 Issued in WA
Practice address
4116 Pueblo HTS
Mount Vernon, WA 98273-8963
Phone
(360) 708-9286
Fax
(360) 424-0549
NPI assigned
Jun 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN00065198 WA Primary

Addresses

Primary practice location

4116 Pueblo HTS
Mount Vernon, WA 98273-8963

Mailing address

4116 Pueblo HTS
Mount Vernon, WA 98273-8963
Phone (360) 708-9286

Other identifiers 1

IdentifierTypeStateIssuer
9635491MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1306889811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4116 PUEBLO HTS",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982738963",
            "telephone_number": "360-708-9286",
            "fax_number": "360-424-0549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4116 PUEBLO HTS",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982738963",
            "telephone_number": "360-708-9286",
            "fax_number": "360-424-0549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYLER",
        "first_name": "MARY",
        "middle_name": "JANE",
        "name_prefix": "Ms.",
        "credential": "RN, ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-13",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WA",
            "license": "RN00065198",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9635491",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.