Provider Demographics
NPI:1902005796
Name:MOLINE, TONYA P (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:P
Last Name:MOLINE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:TONYA
Other - Middle Name:R
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-323-1691
Mailing Address - Fax:859-257-3644
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0293
Practice Address - Country:US
Practice Address - Phone:859-323-1691
Practice Address - Fax:859-257-3644
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005223363LF0000X, 363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100033960Medicaid
KY0169Medicare PIN
KY7100033960Medicaid