Provider Demographics
NPI:1568048486
Name:OWENS, TONIA RENE
Entity Type:Individual
Prefix:
First Name:TONIA
Middle Name:RENE
Last Name:OWENS
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 1:107 DEER CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4197
Mailing Address - Country:US
Mailing Address - Phone:160-139-8536
Mailing Address - Fax:
Practice Address - Street 1:107 DEER CREEK WAY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4197
Practice Address - Country:US
Practice Address - Phone:160-139-8536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS800404522OtherDRIVERS LICENSE