Healthcare Provider Details

I. General information

NPI: 1255286340
Provider Name (Legal Business Name): ALEXANDRA PATRICIA THOMAS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXANDRA PATRICIA KING

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18880 CHERRY VALLEY BLVD
TUOLUMNE CA
95379-9506
US

IV. Provider business mailing address

PO BOX 939
ANGELS CAMP CA
95222-0939
US

V. Phone/Fax

Practice location:
  • Phone: 209-928-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95040636
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95101483
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: