Provider Demographics
NPI:1821574815
Name:MYER, TONI DANIELLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:TONI
Middle Name:DANIELLE
Last Name:MYER
Suffix:
Gender:F
Credentials:APRN
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 1060
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-1060
Mailing Address - Country:US
Mailing Address - Phone:934-479-4041
Mailing Address - Fax:
Practice Address - Street 1:934 N GASKILL ST
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72740-1319
Practice Address - Country:US
Practice Address - Phone:479-738-5500
Practice Address - Fax:479-738-1350
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR233548758Medicaid
ARA005529OtherSTATE BOARD OF NURSING NURSE PRACTITIONER LICENSE