Healthcare Provider Details

I. General information

NPI: 1841486875
Provider Name (Legal Business Name): MS. TANYA ANN THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W 17TH ST
RUSSELLVILLE AR
72801-7113
US

IV. Provider business mailing address

103 W 17TH ST
RUSSELLVILLE AR
72801-7113
US

V. Phone/Fax

Practice location:
  • Phone: 479-567-7045
  • Fax:
Mailing address:
  • Phone: 479-567-7045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: