Provider Demographics
NPI:1528867330
Name:CALLICOAT, TONYA (MS, RDN, LDN)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:
Last Name:CALLICOAT
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 PROVIDENCE HILL DR APT 202
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2296
Mailing Address - Country:US
Mailing Address - Phone:304-638-5779
Mailing Address - Fax:304-638-5779
Practice Address - Street 1:202 PROVIDENCE HILL DR APT 202
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2296
Practice Address - Country:US
Practice Address - Phone:304-638-5779
Practice Address - Fax:304-638-5779
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD09545133V00000X
KY166842133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered