Provider Demographics
NPI:1710038906
Name:MOSES, TONYA LEIGH (CRNP)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:LEIGH
Last Name:MOSES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 GLENN BLVD SW STE 100A
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3546
Mailing Address - Country:US
Mailing Address - Phone:256-997-5900
Mailing Address - Fax:
Practice Address - Street 1:1906 GLENN BLVD SW STE 100A
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3546
Practice Address - Country:US
Practice Address - Phone:256-997-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1072400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630303031Medicaid
ALP00212471OtherMEDICARE RAILROAD RETIREM
AL051500703OtherBLUE CROSS BLUE SHIELD
AL161381Medicaid
AL630302031Medicaid
AL051500697OtherBLUE CROSS BLUE SHIELD
AL051500704OtherBLUE CROSS BLUE SHIELD
AL630306031Medicaid
AL155232Medicaid
AL630309031Medicaid
AL051500695OtherBLUE CROSS BLUE SHIELD
AL051500696OtherBLUE CROSS BLUE SHIELD
AL051500700Medicaid
AL511-40864OtherBCBS LOCATION ID
AL630307031Medicaid
AL630308031Medicaid
AL051500700Medicare ID - Type UnspecifiedMEDICARE
AL051500703OtherBLUE CROSS BLUE SHIELD