Provider Demographics
NPI:1467066514
Name:TYNER, TONYA RENE
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:RENE
Last Name:TYNER
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 1:1406 S DUNCAN ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-5820
Mailing Address - Country:US
Mailing Address - Phone:405-612-2128
Mailing Address - Fax:
Practice Address - Street 1:1406 S DUNCAN ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-5820
Practice Address - Country:US
Practice Address - Phone:405-612-2128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-05
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator