Provider Demographics
NPI:1912212523
Name:TOLSON, TAMERA L (DC)
Entity Type:Individual
Prefix:
First Name:TAMERA
Middle Name:L
Last Name:TOLSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E NEW CIRCLE RD STE 160
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505-4256
Mailing Address - Country:US
Mailing Address - Phone:859-309-0377
Mailing Address - Fax:859-309-0381
Practice Address - Street 1:1300 E NEW CIRCLE RD STE 160
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4256
Practice Address - Country:US
Practice Address - Phone:859-309-0377
Practice Address - Fax:859-309-0381
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1912212523OtherNPI (INDIVIDUAL)
KY50080990OtherPASSPORT
KY7100186170Medicaid
KY757308OtherOPTUMHEALTH
KY1306258488OtherNPI (GROUP)
KY316260OtherCOVENTRY CARES OF KY
KYK136411OtherMEDICARE - PTAN (INDIVIDUAL)
KY000000894822OtherANTHEM
KY7100299290OtherMEDICAID (GROUP)
KYK136410OtherMEDICARE - PTAN (GROUP)
KY000000894820OtherANTHEM (GROUP)
KY1136817OtherAMERICAN SPECIALITY HEALTH