1710058003 NPI number — MRS. XYLDIA LUCKEY THOMAS APRN, WHNP-BC

Table of content: MRS. XYLDIA LUCKEY THOMAS APRN, WHNP-BC (NPI 1710058003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710058003 NPI number — MRS. XYLDIA LUCKEY THOMAS APRN, WHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
XYLDIA
Provider Middle Name:
LUCKEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, WHNP-BC
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:
1710058003
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
71408 NIGHTWALK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABITA SPRINGS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70420-3746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-778-8170
Provider Business Mailing Address Fax Number:
985-898-5005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
377 HIGHWAY 21 STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISONVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70447-3442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-845-4111
Provider Business Practice Location Address Fax Number:
985-845-4004
Provider Enumeration Date:
11/10/2006

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: 363LW0102X , with the licence number:  RN079714 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com