| Doctor Name: | CHARLEY TYRE |
| NPI Number: | 1609204585 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | 5006569 |
| Business Practice Address: | 2627 Winding Cv Grimesland, NC - 278378612 |
| Business Phone Number: | 2522178288 |
| Business Fax Number: | |
| Mailing Address: | 2627 Winding Cv, GRIMESLAND |
| State: | NC |
| Postal Code: | 278378612 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 10/31/2013 |
| NPI Last Update Date: | 10/31/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 5006569 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |