DANIEL LEWIS TYSON (NPI# 1245474667) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245474667 |
| Entity Type | Individual |
| Full Name | DANIEL LEWIS TYSON |
| Credential | IDMT |
| Practice Address |
208 W Casablanca Ave Clovis NM 88103-5009 |
| Practice Telephone | 5757847801 |
| Mailing Telephone | 5757847801 |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2009-04-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1003X |
Military Health Care Provider Specialization: Independent Duty Medical Technicians |
Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912428822 | Daniel Joseph Tyson | Physical Therapist | 3200 Vine St, Cincinnati, OH 45220-2213 | 2017-06-30 |
| Street Address |
208 W CASABLANCA AVE |
| City | CLOVIS |
| State | NM |
| Zip Code | 88103-5009 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619964947 | Roseanne Carol Warner | Nurse Practitioner | 208 W Casablanca Ave, 27 Medical Group Bldg 1400 Cannon Afb, Clovis, NM 88103-5009 | 2005-10-03 |
| 1861902041 | Katherine Ann Craft | Dietitian, Registered | 208 W Casablanca Ave, Clovis, NM 88103-5009 | 2017-10-02 |
| 1801132220 | Dena Levari | Military Health Care Provider | 208 W Casablanca Ave, Clovis, NM 88103-5009 | 2012-12-13 |
| 1851372858 | Robert Dale Bitner | Physician Assistant | 208 W Casablanca Ave, Bldg 1400 Cannon Afb 27 Medical Group, Clovis, NM 88103-5009 | 2005-11-08 |
| 1043208838 | Marla Dianne Buckles | Nurse Practitioner | 208 W Casablanca Ave, 27 Medical Group Bldg 1400 Cannon Afb, Clovis, NM 88103-5009 | 2005-10-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346747151 | Isabella Wolak | Pharmacist | 224 D L Ingram Blvd, Cannon Afb, NM 88103 | 2018-04-09 |
| 1225480544 | Stacey Tatro | Dentist | 224 West D.l. Ingram Ave., Bldg 1408, Cannon Afb, NM 88103 | 2016-07-11 |
| 1871965673 | Chad Bryan Carter | Dentist | 224 W Dl Ingram Ave, Sgpd/dental Clinic, Cannon Air Force Base, NM 88103 | 2015-10-20 |
| 1740660836 | Terah Clifford | Dental Hygienist | 224 W Dl Ingram Blvd, Bldg 1408 Dental Clinic, Cannon Afb, NM 88103 | 2015-06-03 |
| 1528452208 | Taylor Bottari | Physician Assistant | 208 W Dl Ingram, Cannon Afb, NM 88103 | 2015-03-20 |
| 1588071328 | Gretchen Evelynn Szymanski | Nurse Practitioner | Cannon Afb, 224 W D.l. Ingram Blvd, Cannon Afb, NM 88103 | 2014-07-14 |
| 1396155206 | Jennifer Brynn Bendokas | Physician Assistant | 224 West Dl Ingram Avenue, Cannon Afb, NM 88103 | 2014-04-30 |
| 1366889487 | Jeremy Michael Strohmayer | General Practice | 511 Chindt Blvd Building 300, 27soss/osm, Cannon Afb, NM 88103 | 2013-05-30 |
| 1356622401 | Matthew John Nielsen | Dentist | 224 W D.l. Ingram, Bld. 1408, Cannon Afb, NM 88103 | 2011-09-02 |
| 1689965485 | Bryan Wade Sixkiller | Optometrist | 27th Somdg, 208 W. Casa Blanca Ave., Apo, AA 88103 | 2011-04-27 |
| Find all providers in zip 88103 | ||||
| Taxonomy Code | 1710I1003X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Medical Technicians |
| An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians. |
| Notes: Source: Air Force Surgeon General Office [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144797556 | William Murphy Whittle | Military Health Care Provider | 2000 Hallum St, Clovis, NM 88101-8684 | 2018-10-24 |
| 1265983068 | Yurikoaokio Motomochi Livas | Military Health Care Provider | 209 Wilmington Cir, Clovis, NM 88101-9382 | 2016-10-18 |
| 1831438357 | John Frederick Rinaldi | Military Health Care Provider | 3500 Adenmore Ct, Apt C, Clovis, NM 88101 | 2013-02-04 |
| 1740583350 | Norma P Grandberry | Military Health Care Provider | 1501 Westchester St, Clovis, NM 88101-4638 | 2010-12-21 |
| 1609186139 | Jeramy Byrd | Military Health Care Provider | 9410 A Vermont Court, Clovis, NM 88101 | 2010-10-18 |
| 1477879708 | Christopher Gordon Brown | Military Health Care Provider | 717 Sandia Dr, Clovis, NM 88101-4123 | 2010-04-12 |
| 1396989968 | Luis Alberto Hallman | Military Health Care Provider | 3516 Adenmor Ct, Unit B, Clovis, NM 88101-2820 | 2009-04-28 |
| 1689271736 | Sinead Catherine Brosnan | Military Health Care Provider | 208 D L Ingram Ave W, Clovis, NM 88103-5103 | 2020-10-01 |
| 1801132220 | Dena Levari | Military Health Care Provider | 208 W Casablanca Ave, Clovis, NM 88103-5009 | 2012-12-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801496625 | Stephen Kreidler | Military Health Care Provider | 5453 Roosevelt Loop Ne, Rio Rancho, NM 87144-5218 | 2020-10-30 |
| 1134748692 | Patrick James Scollon | Military Health Care Provider | 104 W D. L. Ingram Ave, Cannon Afb, Nm 88101, Cannon Afb, NM 88101 | 2020-04-14 |
| 1245614544 | Rowland Coyle | Military Health Care Provider | 701 Stephen Moody Rd, Albuquerque, NM 87117 | 2015-07-16 |
| 1972939585 | Eugene Navarro Tabita | Military Health Care Provider | 4050a Greenhouse Pl Se, Albuquerque, NM 87116-3008 | 2013-09-16 |
| 1043553217 | Amanda Colyer | Military Health Care Provider | 2050 2nd St Se # A, Albuquerque, NM 87117-5522 | 2013-04-05 |
| 1003176389 | Ricky Franco Vela | Military Health Care Provider | 8101a W Sandia Cir Se, Albuquerque, NM 87116-5501 | 2012-05-21 |
| 1194041426 | Philip Ofimiano Borde Jr. | Military Health Care Provider | 4660 Mesa Rico Dr, Las Cruces, NM 88011-7228 | 2010-04-12 |
| 1285958017 | Michael Wayne Mcfadden | Military Health Care Provider | 2309 Saguaro Loop, Alamogordo, NM 88310-7775 | 2010-03-23 |
| 1952630642 | Michael B Stull | Military Health Care Provider | 904 S Dallas Ave Apt 3, Portales, NM 88130-6028 | 2009-12-09 |
| 1598909012 | Martin Oleen Jensen | Military Health Care Provider | 119 E Arcadia Ave Bldg 622, 27 Special Operations Support Sqdn/osm, Cannon Afb, NM 88103-5112 | 2009-04-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.