1023534401 NPI number — MRS. CANDACE DANIELLE THOMAS PA-C

Table of content: MRS. CANDACE DANIELLE THOMAS PA-C (NPI 1023534401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023534401 NPI number — MRS. CANDACE DANIELLE THOMAS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
CANDACE
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATHERLY
Provider Other First Name:
CANDACE
Provider Other Middle Name:
DANIELLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023534401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 360
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYLVA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28779-0360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-339-6065
Provider Business Mailing Address Fax Number:
828-538-4441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1998 HENDERSONVILLE RD STE 53
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28803-2192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-585-5489
Provider Business Practice Location Address Fax Number:
855-308-2340
Provider Enumeration Date:
08/17/2017

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 3325 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P02580824 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1023534401 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20D34 . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: NNE256A . This is a "MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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