DR. TONYA LAKE (NPI# 1952706236) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952706236 |
| Entity Type | Individual |
| Full Name | DR. TONYA LAKE |
| Credential | NP |
| Practice Address |
3500 N Elm Ave Jackson MI 49201-8887 |
| Practice Telephone | 5177805000 |
| Mailing Telephone | 5177805000 |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2014-10-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
4704226641 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3500 N ELM AVE |
| City | JACKSON |
| State | MI |
| Zip Code | 49201-8887 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477579266 | Edward Luis Rodriguez | Psychiatry & Neurology | 3500 N Elm Ave, Opmh, Jackson, MI 49201-8887 | 2006-07-14 |
| 1801266291 | Katherine Garduno-klynstra | Nurse Practitioner | 3500 N Elm Ave, Jackson, MI 49201-8887 | 2015-09-29 |
| 1972828028 | Charles Jamsen | Internal Medicine | 3500 N Elm Ave, Jackson, MI 49201-8887 | 2010-04-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174137863 | Sally Ann Shaw | Behavior Technician | 3699 Miles Rd., Jackson, MI 49201 | 2020-09-01 |
| 1780293043 | Alyn Kristin Kay | Technician | Hope Network-hope's Door Cru, 3699 Miles Rd., Jackson, MI 49201 | 2020-07-23 |
| 1841827946 | Maverick Jubane | Student in an Organized Health Care Education/Training Program | Henry Ford Allegiance Health, 205 N East Avenue, Jackson, MI 49201 | 2020-03-26 |
| 1306486584 | Cody Williams | Technician, Other | 1001 Laurence Avenue St E, Jackson, MI 49201 | 2020-01-15 |
| 1720632292 | Krystie Lynn Adorjan | Speech-Language Pathologist | 1175 W Parnall Rd, Jackson, MI 49201 | 2019-08-01 |
| 1407412653 | Howard Franklin Tanner II | Speech-Language Pathologist | 102 East Michigan Avenue, Jackson, MI 49201 | 2019-05-14 |
| 1356863740 | Rima Zarar Qayyum | Speech-Language Pathologist | 4800 Firethorn Dr., Jackson, MI 49201 | 2017-07-07 |
| 1306384383 | Briana Nesmith | Speech-Language Pathologist | 2025 Ann Arbor Road, Jackson, MI 49201 | 2017-02-09 |
| 1255878062 | W.a. Foote Memorial Hospital, Inc | Otolaryngology | 205 N.east Ave, Jackson, MI 49201 | 2017-01-31 |
| 1306212881 | Aisha Henderson | Social Worker | 729 West Michigan Avenue, Jackson, MI 49201 | 2015-08-19 |
| Find all providers in zip 49201 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912511981 | Nurture Mental Health & Wellness Center LLC | Nurse Practitioner | 125 S King St Ste 2a, Jackson, WY 83001-8124 | 2020-09-07 |
| 1811511819 | Aretha M. Northington | Nurse Practitioner | 1430 Wingfield Dr., Jackson, MS 39204-4448 | 2020-06-04 |
| 1760921225 | A Beautiful Mind LLC | Nurse Practitioner | 1856 Smallwood St, Jackson, MS 39212-2521 | 2017-02-16 |
| 1013302082 | Tiffany Griffin | Nurse Practitioner | 3450 Highway 80 West, Jackson, MS 39209 | 2015-04-06 |
| 1114311446 | Lakeisha Crye Green | Nurse Practitioner | 5568 Tiki Ln, Jackson, MS 39212-3657 | 2015-03-25 |
| 1205176716 | Robert White LLC | Nurse Practitioner | 2290 West County Line Rd, Suite 105, Jackson, NEW JERSEY 08527 | 2013-02-20 |
| 1699046235 | Matrix Wellness Solutions | Nurse Practitioner | 384 Carriage House Dr Ste D, Suite D, Jackson, TN 38305-2268 | 2012-01-12 |
| 1063721314 | Anna M Cook | Nurse Practitioner | 163 W Univeristy Parkway, Jackson, TN 38305 | 2010-10-05 |
| 1720245848 | Carol Jeanne Dove | Nurse Practitioner | 4044 Briggs Ct, Jackson, MI 49201-9033 | 2008-05-16 |
| 1730203415 | Sherry M Blackford | Nurse Practitioner | 238 Summar Drive, Jackson, TN 38301 | 2007-03-19 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.