Provider Demographics
NPI:1003530866
Name:RICHARDS, TONYA L (LPN)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:L
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 285
Mailing Address - Street 2:
Mailing Address - City:BRUCETON MILLS
Mailing Address - State:WV
Mailing Address - Zip Code:26525-0285
Mailing Address - Country:US
Mailing Address - Phone:304-290-1357
Mailing Address - Fax:
Practice Address - Street 1:511 BURROUGHS ST STE 101
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3389
Practice Address - Country:US
Practice Address - Phone:304-288-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19769164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse