Provider Demographics
NPI:1598373425
Name:PEPPERS, TONYA DANYEL (CFM)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:DANYEL
Last Name:PEPPERS
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 FARM CREEK RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-8517
Mailing Address - Country:US
Mailing Address - Phone:870-273-4245
Mailing Address - Fax:
Practice Address - Street 1:2913 KING ST STE 3
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5353
Practice Address - Country:US
Practice Address - Phone:870-273-4245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARCFM03411224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Single Specialty