Provider Demographics
NPI:1235367251
Name:MASON, TONYA D (NP)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:D
Last Name:MASON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:D
Other - Last Name:WHITFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4537 S NUCOR RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-7969
Mailing Address - Country:US
Mailing Address - Phone:765-362-3579
Mailing Address - Fax:765-362-3662
Practice Address - Street 1:4537 S NUCOR RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-7969
Practice Address - Country:US
Practice Address - Phone:765-362-3579
Practice Address - Fax:765-362-3662
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200951140Medicaid
IN200951140Medicaid