Provider Demographics
NPI:1265894745
Name:WALSTON, TONYA L (DNP)
Entity type:Individual
Prefix:DR
First Name:TONYA
Middle Name:L
Last Name:WALSTON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
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Mailing Address - Street 1:6164 FULLER CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2540
Mailing Address - Country:US
Mailing Address - Phone:703-924-9810
Mailing Address - Fax:703-924-7044
Practice Address - Street 1:6164 FULLER CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2540
Practice Address - Country:US
Practice Address - Phone:703-924-9810
Practice Address - Fax:703-924-7044
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024173415363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health