Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | SP024906 | PA |
N | 363LA2200X | Nurse Practitioner - Adult Health | SP024906 | PA |
N | 363LC1500X | Nurse Practitioner - Community Health | SP024906 | PA |
N | 363LP0200X | Nurse Practitioner - Pediatrics | SP024906 | PA |
N | 363LP2300X | Nurse Practitioner - Primary Care | SP024906 | PA |
NPI | 1457006025 |
---|---|
Provider Name | Ty Mitchell Geesey |
First Address | Mechanicsburg, PA 17055-9728 |
Second Address | Mechanicsburg, PA 17055-9728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2022 |
Last Update Date | 13/02/2022 |