Provider Demographics
NPI:1881633733
Name:TILTON, TONI L (CRNA)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:L
Last Name:TILTON
Suffix:
Gender:F
Credentials:CRNA
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 1382
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-0024
Mailing Address - Country:US
Mailing Address - Phone:270-871-5546
Mailing Address - Fax:
Practice Address - Street 1:1659 RYAN AVE
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-1768
Practice Address - Country:US
Practice Address - Phone:270-871-5546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1071881174400000X
OH316879367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8242233OtherMEDICARE PIN
OH8242231OtherMEDICARE PIN
OH8242232Medicare PIN