Provider Demographics
NPI:1407308943
Name:WALLS, TONYA A
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:A
Last Name:WALLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WYNDSOR CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-9601
Mailing Address - Country:US
Mailing Address - Phone:629-239-7584
Mailing Address - Fax:
Practice Address - Street 1:1047 GLENBROOK WAY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-1315
Practice Address - Country:US
Practice Address - Phone:629-239-7584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN664243197246Z00000X
TN21715363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily