Provider Demographics
NPI:1720228232
Name:MACKEY, TONYA R (LMP)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:R
Last Name:MACKEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12420 E APACHE PASS RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99206-8318
Mailing Address - Country:US
Mailing Address - Phone:509-230-1563
Mailing Address - Fax:
Practice Address - Street 1:708 N ARGONNE RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2760
Practice Address - Country:US
Practice Address - Phone:509-230-1563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00025090172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker