Provider Demographics
NPI:1194109777
Name:SHEPHERD HATFIELD, TONYA R (APRN)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:R
Last Name:SHEPHERD HATFIELD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:EASTERN
Mailing Address - State:KY
Mailing Address - Zip Code:41622-0193
Mailing Address - Country:US
Mailing Address - Phone:606-226-8677
Mailing Address - Fax:
Practice Address - Street 1:338 KY ROUTE 550
Practice Address - Street 2:
Practice Address - City:EASTERN
Practice Address - State:KY
Practice Address - Zip Code:41622-0193
Practice Address - Country:US
Practice Address - Phone:606-949-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100371120Medicaid