Provider Demographics
NPI:1669672275
Name:REDDY, TONYA LEE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:LEE
Last Name:REDDY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:L
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2403
Mailing Address - Country:US
Mailing Address - Phone:217-528-7541
Mailing Address - Fax:
Practice Address - Street 1:800 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-3719
Practice Address - Country:US
Practice Address - Phone:217-528-7541
Practice Address - Fax:217-753-1707
Is Sole Proprietor?:No
Enumeration Date:2007-07-21
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.006671363LF0000X
IL277000138363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1669672275Medicare UPIN
IL1669672275Medicaid