Provider Demographics
NPI:1962986398
Name:TAWNYA PEERY, LLC
Entity type:Organization
Organization Name:TAWNYA PEERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHP-BC
Authorized Official - Prefix:
Authorized Official - First Name:TAWNYA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:PEERY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:580-222-8680
Mailing Address - Street 1:1108 W. WALNUT DRIVE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401
Mailing Address - Country:US
Mailing Address - Phone:580-798-3966
Mailing Address - Fax:
Practice Address - Street 1:1108 W. WALNUT DRIVE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:580-657-3732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty