Provider Demographics
NPI:1588102305
Name:GOLLAHALLI, TONYA LYNETTE (PA-C)
Entity type:Individual
Prefix:MS
First Name:TONYA
Middle Name:LYNETTE
Last Name:GOLLAHALLI
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:825 NE 10TH ST
Mailing Address - Street 2:OUPB 4E
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5417
Mailing Address - Country:US
Mailing Address - Phone:405-271-3445
Mailing Address - Fax:405-271-3401
Practice Address - Street 1:825 NE 10TH ST
Practice Address - Street 2:OUPB 4E
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5417
Practice Address - Country:US
Practice Address - Phone:405-271-3445
Practice Address - Fax:405-271-3401
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
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Provider Licenses
StateLicense IDTaxonomies
OK2733363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant