Provider Demographics
NPI:1750691804
Name:HACKLER, TONYA LAVERN
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:LAVERN
Last Name:HACKLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 956
Mailing Address - Street 2:
Mailing Address - City:PINE KNOT
Mailing Address - State:KY
Mailing Address - Zip Code:42635-0956
Mailing Address - Country:US
Mailing Address - Phone:606-354-4053
Mailing Address - Fax:
Practice Address - Street 1:1069 E HWY 92
Practice Address - Street 2:
Practice Address - City:PINE KNOT
Practice Address - State:KY
Practice Address - Zip Code:42635-0956
Practice Address - Country:US
Practice Address - Phone:606-354-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator