1528729688 NPI number — FELICIA R THOMAS

Table of content: FELICIA R THOMAS (NPI 1528729688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528729688 NPI number — FELICIA R THOMAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
FELICIA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1528729688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5124 PAINTED WOODS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89081-2306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-830-4458
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7629 VALLEY GREEN DR UNIT 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89149-0350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-812-5567
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/31/2021

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: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1066071610 . This is a "DRIVERS LICENSR" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 1606071610 . This is a "DRIVERS LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".