Provider Demographics
NPI:1053336081
Name:BREEDING, TONYA (PA-C)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:BREEDING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 NICHOLASVILLE RD
Mailing Address - Street 2:SUTIE 601
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1404
Mailing Address - Country:US
Mailing Address - Phone:859-277-5887
Mailing Address - Fax:859-276-7638
Practice Address - Street 1:1720 NICHOLASVILLE RD
Practice Address - Street 2:SUTIE 601
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1404
Practice Address - Country:US
Practice Address - Phone:859-277-5887
Practice Address - Fax:859-276-7638
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA503363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9500270500Medicaid
KY0212436Medicare PIN
KY9500270500Medicaid