Healthcare Provider Details

I. General information

NPI: 1447187182
Provider Name (Legal Business Name): DAVA R THOMAS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 CENTRAL AVE
LAUREL MS
39440
US

IV. Provider business mailing address

14 DOCS LN
ELLISVILLE MS
39437-6081
US

V. Phone/Fax

Practice location:
  • Phone: 601-580-2513
  • Fax:
Mailing address:
  • Phone: 601-580-7042
  • Fax: 331-204-1117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number908400
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: