Provider Demographics
NPI:1750357547
Name:KNOLL, TONYA (DO)
Entity type:Individual
Prefix:DR
First Name:TONYA
Middle Name:
Last Name:KNOLL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2422
Mailing Address - Country:US
Mailing Address - Phone:785-625-5500
Mailing Address - Fax:785-625-5501
Practice Address - Street 1:1106 E 27TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2154
Practice Address - Country:US
Practice Address - Phone:785-625-5500
Practice Address - Fax:785-625-5501
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-29277207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100456020AMedicaid
KS100456020AMedicaid
KSH94762Medicare UPIN