MITZI BRADDOCK TYRE FNP NPI 1396983227

NPI Information

  • NPI: 1396983227
  • Provider Name: MITZI BRADDOCK TYRE, FNP
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1007 MARY ST
    WAYCROSS, GA
    ZIP 31503
  • Phone: (912) 387-7737

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NPI Details

Mitzi Braddock Tyre, FNP is a psychiatric/mental health nurse practitioner in Waycross, GA with 5 years of experience. Mitzi Braddock Tyre, FNP NPI is 1396983227. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1007 MARY ST
WAYCROSS, GA
ZIP 31503-823
Phone: (912) 387-7737
Fax: (912) 449-7080

The NPI 1396983227 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Established patient office or other outpatient visit, 20-29 minutes (HCPCS:99213)
  • Telehealth originating site facility fee (HCPCS:Q3014)

The enumeration date for this NPI number is 1/30/2009 and was last updated on 8/20/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1163W00000XRegistered NurseRN170702GEORGIANo
2363LF0000XNurse PractitionerFamilyRN170702GEORGIANo
3363LP0808XNurse PractitionerPsychiatric/Mental HealthRN170702GEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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