Provider Demographics
NPI:1801816574
Name:MILLER, TONYA K (NP)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:K
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ORTHOPEDIC WAY
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1240
Mailing Address - Country:US
Mailing Address - Phone:304-599-0720
Mailing Address - Fax:304-599-3962
Practice Address - Street 1:200 ORTHOPEDIC WAY
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1240
Practice Address - Country:US
Practice Address - Phone:304-599-0720
Practice Address - Fax:304-599-3962
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV49659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006889Medicaid
WV001914010OtherBLUE CROSS
WVWV4293D351Medicare PIN