TYLER LEE VERNON DO
NPI 1558065094
Student in an Organized Health Care Education/Training Program in Indianapolis, IN

Q: What is Tyler Vernon's NPI number?

The NPI number for Tyler Vernon is 1558065094. It was assigned to this individual provider in the NPPES registry on March 29, 2023.

Q: What is Tyler Vernon's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: Is Tyler Vernon enrolled in Medicare?

No. Tyler Vernon has opted out of Medicare through May 31, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Tyler Vernon was last updated on June 14, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 29, 2023Opted out of Medicare · through May 31, 2028

10122 E 10TH ST STE 100, INDIANAPOLIS, IN 46229(317) 355-5717 Get Directions Write a Review

NPPES record last updated: June 14, 2023. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Jun 14, 2023, Mar 29, 2023 (2 updates tracked since 2023).

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About Tyler Lee Vernon Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TYLER LEE VERNON DO (NPI 1558065094) is an individual student in an organized health care education/training program in Indianapolis, Indiana, licensed in Indiana (11023099A) and active in the NPI registry since March 2023. He has opted out of Medicare through May 31, 2028.

NPPES Registry Identity

NPI1558065094

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameTYLER LEE VERNONCredential: DO

Location Address10122 E 10TH ST STE 100Indianapolis, IN 46229-2697

Mailing Address10122 E 10th St Ste 100Indianapolis, IN 46229-2697 · (317) 355-5717

Phone(317) 355-5717

Sole ProprietorNo

Enumeration DateMarch 29, 2023

Last NPPES UpdateJune 14, 20232 updates tracked since enumeration

NPPES CertifiedJune 14, 2023

✔ NPI 1558065094 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

License✔ Licensed in IN · 11023099A

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

10122 E 10TH ST STE 100, Indianapolis, IN 46229

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Other Identifiers 1

Medicaid300076260IN

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Tyler Lee Vernon Do has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from May 31, 2026 through May 31, 2028.

Opt-Out Effective DateMay 31, 2026

Opt-Out In Effect ThroughMay 31, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LAUREN AMANDA CALLAHAN

Nurse Practitioner (Family)