MEDICARE: TONI VAN ORMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1265244842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONI VAN ORMAN

Provider Business Mailing Address
First Line	:	158 MISSISSIPPI LOOP
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-1128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6110 T P WHITE DR
Second Line	:
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076
Country	:	US
Telephone Number	:	702-622-1096
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	01/22/2025

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Directions to “ TONI VAN ORMAN ” Practice Location

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