Healthcare Provider Details

I. General information

NPI: 1144713280
Provider Name (Legal Business Name): MICHELLE YVONNE THOMAS WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BILLINGSLEY RD STE 100
CHARLOTTE NC
28211
US

IV. Provider business mailing address

5960 FAIRVIEW RD STE 500
CHARLOTTE NC
28210-3113
US

V. Phone/Fax

Practice location:
  • Phone: 704-405-3953
  • Fax:
Mailing address:
  • Phone: 704-918-1934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704268840
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5013804
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: