Healthcare Provider Details

I. General information

NPI: 1528425501
Provider Name (Legal Business Name): ERIC RICHARD THOMASON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 S MADISON ST STE D
WEBB CITY MO
64870-3044
US

IV. Provider business mailing address

1715 S MADISON ST STE D
WEBB CITY MO
64870-3044
US

V. Phone/Fax

Practice location:
  • Phone: 620-605-5766
  • Fax: 417-605-5655
Mailing address:
  • Phone: 620-605-5766
  • Fax: 417-605-5655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-78593
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: