Tonyia Katric Pender, CEO

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

0002064084 Issued in VA

Practice address

10555 S Crater Rd
South Prince George, VA 23805-7333

Phone

(804) 919-2897

NPI assigned

Nov 7, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Premier Enrichment Services, LLC

  • Developmentally Disabled Services Day Training Agency
  • South Prince George, VA
  • NPI 1306644661
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730937600000",
    "number": "1366265274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23308 PHEASANT CT",
            "city": "NORTH DINWIDDIE",
            "state": "VA",
            "postal_code": "238038380",
            "telephone_number": "804-919-2897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10555 S CRATER RD",
            "city": "SOUTH PRINCE GEORGE",
            "state": "VA",
            "postal_code": "238057333",
            "telephone_number": "804-919-2897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDER",
        "first_name": "TONYIA",
        "middle_name": "KATRIC",
        "name_prefix": "Mrs.",
        "credential": "CEO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-11-07",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "VA",
            "license": "0002064084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emma Layne Moody
• Jodie Pointer Myers, RDH
• Tonja New
• Shannon Oconnor
• Bethany Pagano
• Cheryl Edwards Ponton, LPC-R
• Premier Enrichment Services, LLC
• Malissa Ann Quinlan Farnum, CSAC-S
• Candace Raburn
• Charlisa Rhodes, LPN

• Licensed Practical Nurse in South Prince George, VA
• Providers in South Prince George, VA by specialty
• Licensed Practical Nurse in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.