| NPI | 1144558404 |
|---|---|
| Former Name | KIMBERLY ANNE TYRA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA APRN-CNS-PMH119081) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN119081) |
| Enumeration Date | 2009-11-25 |
| Last Update Date | 2025-10-27 |