1497412977 NPI number — ANGELA THOMAS PMHNP

Table of content: ANGELA THOMAS PMHNP (NPI 1497412977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497412977 NPI number — ANGELA THOMAS PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
ANGELA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497412977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3101 N CENTRAL AVE STE 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85012-2635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-230-7373
Provider Business Mailing Address Fax Number:
602-682-7455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3330 N 2ND ST STE 601
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85012-2395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-230-7373
Provider Business Practice Location Address Fax Number:
602-230-5105
Provider Enumeration Date:
11/19/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  TEMP263583 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: AP-268904 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)