Healthcare Provider Details

I. General information

NPI: 1477017861
Provider Name (Legal Business Name): ASHLEY HALCOMB THOMAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 CALVERT DR
ALEXANDRIA LA
71303-3520
US

IV. Provider business mailing address

37 CALVERT DR
ALEXANDRIA LA
71303-3520
US

V. Phone/Fax

Practice location:
  • Phone: 318-443-9634
  • Fax: 318-443-9809
Mailing address:
  • Phone: 318-443-9634
  • Fax: 318-443-9809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN098999
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-36622
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: