Provider Demographics
NPI:1700028966
Name:PARSON, TONYA D (APN)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:D
Last Name:PARSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000 DEPT 978
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-2948
Mailing Address - Country:US
Mailing Address - Phone:901-756-5565
Mailing Address - Fax:901-756-5564
Practice Address - Street 1:865 WILLOW TREE CIR STE 100
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6377
Practice Address - Country:US
Practice Address - Phone:901-681-2701
Practice Address - Fax:901-681-2702
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011388363L00000X, 363LA2100X
TNAPN11388363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522557Medicaid
TNQ060390Medicaid