Provider Demographics
NPI:1942581095
Name:BRAGG-UNDERWOOD, TONYA MONIQUE (DNP, PMHNP-BC, FNP-B)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:MONIQUE
Last Name:BRAGG-UNDERWOOD
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC, FNP-B
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:MONIQUE
Other - Last Name:BRAGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:117 BROOKDALE DR
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-2077
Mailing Address - Country:US
Mailing Address - Phone:270-590-3352
Mailing Address - Fax:
Practice Address - Street 1:351 PASCOE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-6302
Practice Address - Country:US
Practice Address - Phone:270-590-3352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007120363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily