Provider Demographics
NPI:1689037277
Name:WASHINGTON, TONYA TAURSETTE
Entity Type:Individual
Prefix:MISS
First Name:TONYA
Middle Name:TAURSETTE
Last Name:WASHINGTON
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 1:14 JAMES BROWN AVE
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-8704
Mailing Address - Country:US
Mailing Address - Phone:601-660-2625
Mailing Address - Fax:
Practice Address - Street 1:615 EE WALLACE BLVD S
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334
Practice Address - Country:US
Practice Address - Phone:318-757-9363
Practice Address - Fax:318-757-9364
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1538236328OtherNPI