Jeanette Flores Tyler

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P020881 Issued in NC

Practice address

1560 Haire Rd
Shannon, NC 28386-9092

Phone

(910) 758-6918

NPI assigned

May 31, 2023

Last updated

Jul 1, 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1685491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1831882414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 HAIRE RD",
            "city": "SHANNON",
            "state": "NC",
            "postal_code": "283869092",
            "telephone_number": "910-758-6918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 HAIRE RD",
            "city": "SHANNON",
            "state": "NC",
            "postal_code": "283869092",
            "telephone_number": "910-758-6918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLORES TYLER",
        "first_name": "JEANETTE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-31",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P020881",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Shannon, NC
• Providers in Shannon, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; 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.