Provider Demographics
NPI:1679285993
Name:CLUTTER, TYLER STEPHEN (PA-C)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:STEPHEN
Last Name:CLUTTER
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:5215 HOLY CROSS PKWY
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1469
Mailing Address - Country:US
Mailing Address - Phone:574-523-3160
Mailing Address - Fax:574-523-3221
Practice Address - Street 1:5215 HOLY CROSS PKWY
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1469
Practice Address - Country:US
Practice Address - Phone:574-523-3160
Practice Address - Fax:574-523-3221
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical