Healthcare Provider Details

I. General information

NPI: 1134699218
Provider Name (Legal Business Name): MICHAEL THEY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 TULLY RD
MODESTO CA
95350-4031
US

IV. Provider business mailing address

PO BOX 578688
MODESTO CA
95357-8688
US

V. Phone/Fax

Practice location:
  • Phone: 866-240-8517
  • Fax: 209-497-8337
Mailing address:
  • Phone: 866-240-8517
  • Fax: 209-497-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95010524
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95010524
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberNP95010524
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: