Healthcare Provider Details

I. General information

NPI: 1407476336
Provider Name (Legal Business Name): DESTIN THOMAS PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 MEDICAL PARK LOOP
SYLVA NC
28779-5271
US

IV. Provider business mailing address

141 SIMS CIR
WAYNESVILLE NC
28786-3035
US

V. Phone/Fax

Practice location:
  • Phone: 828-307-0900
  • Fax: 866-340-6013
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5017612
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201805
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: