Provider Demographics
NPI:1568162113
Name:HERRON, TONYA CROCKETT
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:CROCKETT
Last Name:HERRON
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 1:16926 PORTERS INN DR UNIT 303
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2575
Mailing Address - Country:US
Mailing Address - Phone:704-502-2669
Mailing Address - Fax:
Practice Address - Street 1:650 PENNSYLVANIA AVE SE STE 330
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4397
Practice Address - Country:US
Practice Address - Phone:202-864-4184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker