Basic Information
| Provider Information | |||||||||
| NPI: | 1689037277 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WASHINGTON | ||||||||
| FirstName: | TONYA | ||||||||
| MiddleName: | TAURSETTE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 JAMES BROWN AVE | ||||||||
| Address2: | |||||||||
| City: | NATCHEZ | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391208704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016602625 | ||||||||
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| Practice Location | |||||||||
| Address1: | 615 EE WALLACE BLVD S | ||||||||
| Address2: | |||||||||
| City: | FERRIDAY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187579363 | ||||||||
| FaxNumber: | 3187579364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2016 | ||||||||
| LastUpdateDate: | 05/23/2018 | ||||||||
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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 | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
ID Information
| ID | Type | State | Issuer | Description | 1538236328 | 01 | LA | NPI | OTHER |