Provider Demographics
NPI:1922604651
Name:MCDANIEL, TOMMA KAY (APRN)
Entity Type:Individual
Prefix:
First Name:TOMMA
Middle Name:KAY
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:APRN
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 184
Mailing Address - Street 2:
Mailing Address - City:NEWBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26410-0184
Mailing Address - Country:US
Mailing Address - Phone:304-892-7019
Mailing Address - Fax:
Practice Address - Street 1:337
Practice Address - Street 2:WATER STREET
Practice Address - City:NEWBURG
Practice Address - State:WV
Practice Address - Zip Code:26410
Practice Address - Country:US
Practice Address - Phone:304-892-7019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV107892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty