MITZI BRADDOCK TYRE (FNP) – Psychiatric/Mental Health Nurse Practitioner, NPI 1396983227

MITZI BRADDOCK TYRE (FNP) is a healthcare provider. based in Savannah, Georgia. specializing in NURSE PRACTITIONER. They hold the professional credentials FNP. They hold a License No. RN170702 (GA). The NPI Number for MITZI BRADDOCK TYRE (FNP) is 1396983227

Main info

Female
Sole Proprietor
6 Years Of Experience
Accepts Medicare Assignment
Name
MITZI BRADDOCK TYRE (FNP)
NPI
1396983227
Phone
(912) 349-9777
Address
5 Executive Cir
Enumeration Date
30 January 2009
Last Update Date
20 August 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
2020 (6 years ago)
PAC ID
6800065582
Group Practice PAC ID
4082150818
Professional Enrollment ID
I20110815000504
Address ID
GA315102704Al204XXSTXX400
Telehealth
Yes
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience68
Completeness75
Years active:17State licenses:1Digital endpointsOther names

9,652 NURSE PRACTITIONER in GA

Provider Addresses for MITZI BRADDOCK TYRE (FNP)

  • 5 Executive Cir

    Savannah, GA 314063345

    Phone: (912) 349-9777

    Type: Location

  • 2900 MOSSY OAK TRL

    WAYCROSS, GA 315034621

    Phone: (912) 387-7737

    Type: Mailing

  • 1007 MARY ST

    WAYCROSS, GA 315033823

    Phone: (912) 387-7737

    Fax: (912) 449-7080

    Type: Location

  • 711, Knight Avenue, Waycross, Ware County, Georgia, 31501, United States

    WAYCROSS, GA 315011943

    Phone: (912) 548-0710

    Fax: (912) 548-0071

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 11 Open Payments records for all available years, with a total value of $431.

Total Amount is formed as General ($431) + Research ($0) + Ownership ($0) = $431.

Last reported payment date: 2024-10-29 • Largest payer in this snapshot: Alkermes, Inc. ($184).

Total Amount

$431

General + Research + Ownership

Payments

11

Total payment records

General Amount

$431

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-10-29

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-10-10

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20110815000504INurse PractitionerGATBD
I20241010001976INurse PractitionerFLTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes5632$0
Q3014Telehealth originating site facility fee2717$0
90792Psychiatric diagnostic evaluation with medical services1914$0
View full utilization report →

Insurance plans in this area (ZIP 31406)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4082150818View full group profile
NameSpecialtyState
Mental Health CounselorGA
Nurse PractitionerGA

Reviews

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Frequently asked questions

Does MITZI BRADDOCK TYRE (FNP) have a public NPI I can cite?
Public records show MITZI BRADDOCK TYRE (FNP) under NPI 1396983227.
Quick check: is MITZI BRADDOCK TYRE (FNP) active?
Public NPPES data shows MITZI BRADDOCK TYRE (FNP) with an active NPI status right now.
How should patients interpret MITZI BRADDOCK TYRE (FNP)'s specialty?
The extract shows Psychiatric/Mental Health Nurse Practitioner for MITZI BRADDOCK TYRE (FNP). Clinical services aligned with this taxonomy classification.
Which community is linked to MITZI BRADDOCK TYRE (FNP)?
MITZI BRADDOCK TYRE (FNP) shows a connection to Savannah, Georgia in registry-derived data.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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