Provider Demographics
NPI:1952689580
Name:KALLMEYER, TONYA A (PA)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:A
Last Name:KALLMEYER
Suffix:
Gender:F
Credentials:PA
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 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-301-5901
Mailing Address - Fax:859-301-5940
Practice Address - Street 1:1400 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-2570
Practice Address - Country:US
Practice Address - Phone:859-301-5901
Practice Address - Fax:859-301-5940
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC708363A00000X
VA0110003641363AM0700X
KYPA2356363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical