MEDICARE: MRS. TONYA LISA PATTON

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	237700000X	Hearing Instrument Specialist	HA0622	MS

General Provider Information

NPI Number	:	1629481890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TONYA LISA PATTON

Provider Business Mailing Address
First Line	:	6104 MORNING SIDE DR
Second Line	:
City	:	VANCLEAVE
State	:	MS
Zip	:	39565-6657
Country	:	US
Telephone Number	:	769-223-5479
Fax Number	:

Provider Business Practice Location Address
First Line	:	2112 BIENVILLE BLVD
Second Line	:	SUITE I
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3052
Country	:	US
Telephone Number	:	228-818-9555
Fax Number	:

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

Provider Enumeration Date	:	06/05/2014
Last Update Date	:	06/05/2014

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