Basic Information
| Provider Information | |||||||||
| NPI: | 1346235421 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEDDER | ||||||||
| FirstName: | TONA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1268 SOUTH FOURTH STREET SUITE A | ||||||||
| Address2: | CARESOUTH CAROLINA, INC. | ||||||||
| City: | HARTSVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295504311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433323422 | ||||||||
| FaxNumber: | 8433323985 | ||||||||
| Practice Location | |||||||||
| Address1: | 1268 SOUTH FOURTH ST SUITE A | ||||||||
| Address2: | CARESOUTH CAROLINA, INC. | ||||||||
| City: | HARTSVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295504311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433323422 | ||||||||
| FaxNumber: | 8433323985 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 09/01/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 887 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | P00906620 | 01 | SC | RAILROAD MEDICARE PTAN | OTHER | NP1047 | 05 | SC | MEDICAID |