| Doctor Name: | TYLER LADNER |
| NPI Number: | 1093100752 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | PA00243 |
| Business Practice Address: | 308 Corporate Dr Ridgeland, MS - 391578803 |
| Business Phone Number: | 6018987527 |
| Business Fax Number: | |
| Mailing Address: | 119 Murial St, CLINTON |
| State: | MS |
| Postal Code: | 390564407 |
| Phone Number: | 2283431801 |
| Fax Number: | |
| NPI Enumeration Date: | 03/31/2015 |
| NPI Last Update Date: | 03/31/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | PA00243 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |