Mitzi Braddock Tyre, FNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN170702 Issued in GA

Practice address

1007 Mary St
Waycross, GA 31503-3823

Phone

(912) 387-7737

Fax

(912) 449-7080

NPI assigned

Jan 30, 2009

Last updated

Aug 20, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Mitz Braddock Tyre Other name

Medicare fee-for-service enrollment

Enrolled in GA, FL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Unison Behavioral HealthGroup PAC ID 7517852247, 19 clinicians

Sound Mind Psychiatric Solutions LLCGroup PAC ID 4082150818, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Sound Mind Psychiatric Solutions LLC

  • Psychiatry Physician
  • Alma, GA
  • NPI 1780420877

  FL, Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD
• Unison Behavioral Health

  • Community/Behavioral Health Agency
  • Waycross, GA
  • NPI 1528104866
  Medicare reassignment Care Compare group NPD
• Mayo Clinic Health System in Waycross, Inc.

  • Multi-Specialty Clinic/Center
  • Waycross, GA
  • NPI 1154745982
  Medicare reassignment NPD
• K Somanath MD Inc

  dba Psychiatry Treatment Centers

  • Psychiatry Physician
  • Los Angeles, CA
  • NPI 1649998022

  GA, Psychiatric/Mental Health

  Medicare reassignment NPD
• Applecare LLC

  • Urgent Care Clinic/Center
  • Brunswick, GA
  • NPI 1336257179
  NPD
• Unison Behavioral Health

  • Counselor
  • Homerville, GA
  • NPI 1427368539
  NPD
• Integrated Regional Laboratories Pathology Services, LLC

  dba IRL Pathology Services

  • Anatomic Pathology & Clinical Pathology Physician
  • Atlantis, FL
  • NPI 1942526298
  NPD

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

{
    "created_epoch": "1233273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1396983227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 MOSSY OAK TRL",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315034621",
            "telephone_number": "912-387-7737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 MARY ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315033823",
            "telephone_number": "912-387-7737",
            "fax_number": "912-449-7080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5 Executive Cir",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314063345",
            "country_code": "US",
            "telephone_number": "912-349-9777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TYRE",
        "first_name": "MITZI",
        "middle_name": "BRADDOCK",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-01-30",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN170702",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN170702",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN170702",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MITZ",
            "last_name": "TYRE",
            "middle_name": "BRADDOCK",
            "credential": "FNP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Dale Tucker, MD
• Robert W Tucker, PA
• Lauren Carden Turner
• Tiffany Denise Tyler
• Kennon Latrell Tyre III, PHARM.D.
• Uchenna Ukoha
• Unison Behavioral Health
• Unison Behavioral Health
• Unison Behavioral Health (Satilla Community Services)
• Unison Behavioral Health

• Psychiatric/Mental Health Nurse Practitioner in Waycross, GA
• Providers in Waycross, GA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.