MEDICARE: ASHLEY NICOLE THOMAS MSN, APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	1-143463	AL
2	363LF0000X	Family Nurse Practitioner	F09191047	AL

General Provider Information

NPI Number	:	1629629852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY NICOLE THOMAS MSN, APRN, FNP-C

Provider Business Mailing Address
First Line	:	513 ANTLER DR
Second Line	:
City	:	ENTERPRISE
State	:	AL
Zip	:	36330-2279
Country	:	US
Telephone Number	:	334-406-0464
Fax Number	:

Provider Business Practice Location Address
First Line	:	3138 ROSS CLARK CIR
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36303-3038
Country	:	US
Telephone Number	:	334-504-7014
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2019
Last Update Date	:	03/10/2020

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