Provider Demographics
NPI:1861593162
Name:MATSON, TONYA CHARLENE (ARNP)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:CHARLENE
Last Name:MATSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6922 S WESTERN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-1803
Mailing Address - Country:US
Mailing Address - Phone:405-631-0483
Mailing Address - Fax:405-632-4588
Practice Address - Street 1:6922 S WESTERN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-1803
Practice Address - Country:US
Practice Address - Phone:405-631-0483
Practice Address - Fax:405-632-4588
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0044651363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKS73997Medicare UPIN