Healthcare Provider Details

I. General information

NPI: 1508431370
Provider Name (Legal Business Name): CYNTHIA THOMAS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 01/07/2023
Certification Date: 01/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 INDIANA AVE
KENNER LA
70065-4605
US

IV. Provider business mailing address

501 ROBERT BLVD
SLIDELL LA
70458-1667
US

V. Phone/Fax

Practice location:
  • Phone: 504-575-3700
  • Fax:
Mailing address:
  • Phone: 985-607-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number904638
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: