Healthcare Provider Details

I. General information

NPI: 1245743913
Provider Name (Legal Business Name): SONYA RENEE THOMAS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SONYA RENEE PETERSON APRN

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 11TH ST NE
SPRINGHILL LA
71075-4503
US

IV. Provider business mailing address

1982 OLD PLAIN DEALING RD
BENTON LA
71006-0101
US

V. Phone/Fax

Practice location:
  • Phone: 318-539-1701
  • Fax: 318-539-1725
Mailing address:
  • Phone: 870-918-4973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09837
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: