Provider Demographics
NPI:1972183739
Name:STELLY, TONYA GREENE (CNP)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:GREENE
Last Name:STELLY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13170 DUTCHTOWN POINT AVE APT 1421
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-0105
Mailing Address - Country:US
Mailing Address - Phone:225-773-0942
Mailing Address - Fax:
Practice Address - Street 1:13170 DUTCHTOWN POINT AVE APT 1421
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-0105
Practice Address - Country:US
Practice Address - Phone:225-773-0942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA219194363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAUNKNOWNMedicaid