Provider Demographics
NPI:1629481890
Name:PATTON, TONYA LISA
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:LISA
Last Name:PATTON
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 1:6104 MORNING SIDE DR
Mailing Address - Street 2:
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-6657
Mailing Address - Country:US
Mailing Address - Phone:769-223-5479
Mailing Address - Fax:
Practice Address - Street 1:2112 BIENVILLE BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3052
Practice Address - Country:US
Practice Address - Phone:228-818-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSHA0622237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist