Provider Demographics
NPI:1568828721
Name:PICKENS, TONYA RENEE
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:RENEE
Last Name:PICKENS
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 1:95 CLAIBORNE JONES RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-9167
Mailing Address - Country:US
Mailing Address - Phone:601-381-0875
Mailing Address - Fax:
Practice Address - Street 1:95 CLAIBORNE JONES RD
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-9167
Practice Address - Country:US
Practice Address - Phone:601-381-0875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health