Individual
TONYA COBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
460 WILSON AVE, VERSAILLES, KY 40383-1947
(859) 879-0111
(859) 879-0363
Mailing address
460 WILSON AVE, VERSAILLES, KY 40383-1947
(859) 879-0111
(859) 879-0363
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA452
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95004529
—
KY
Enumeration date
08/02/2005
Last updated
06/09/2022
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