Individual provider · Type 1 NPI
Justine Koerner Tye, CPNP
Pediatric Nurse Practitioner · Little River, SC
NPI number
1366724098
Active
Practice location
4303 Live Oak Dr
Little River, SC 29566-9138
Fax (843) 663-1017
Mailing address
PO Box 547
Little River, SC 29566-0547
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 160512 (NC) |
| Pediatric Nurse Practitioner | 363LP0200X | 5005317 (NC) |
| Pediatric Nurse Practitioner Primary | 363LP0200X | 32732 (SC) |
Pediatric Nurse Practitioner: Definition to come...
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About NPI 1366724098
Justine Koerner Tye, CPNP's National Provider Identifier is 1366724098, issued on Sep 20, 2011. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Little River, SC. The record was last updated on Oct 22, 2026.