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NPI Code Detail

MEDICARE: MYRANDA NICOLE THOMAS

MEDICARE: MYRANDA NICOLE THOMAS
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
1363L00000XNurse Practitioner209026612IL

General Provider Information

NPI Number : 1710676713
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYRANDA NICOLE THOMAS
Provider Business Mailing Address
First Line : PO BOX 3988
Second Line :
City : CARBONDALE
State : IL
Zip : 62902-3988
Country : US
Telephone Number : 618-457-5200
Fax Number :
Provider Business Practice Location Address
First Line : 2601 W MAIN ST
Second Line :
City : CARBONDALE
State : IL
Zip : 62901-1031
Country : US
Telephone Number : 618-549-5361
Fax Number : 618-351-4878
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2023
Last Update Date : 05/05/2026

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Directions to “ MYRANDA NICOLE THOMAS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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