Provider Demographics
NPI:1932627387
Name:BARDSHER, TONYA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:
Last Name:BARDSHER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 SW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-7005
Mailing Address - Country:US
Mailing Address - Phone:580-699-7699
Mailing Address - Fax:580-699-7698
Practice Address - Street 1:916 SW 38TH ST STE D
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-7005
Practice Address - Country:US
Practice Address - Phone:580-699-7699
Practice Address - Fax:580-699-7698
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK96551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily