Healthcare Provider Details

I. General information

NPI: 1265953723
Provider Name (Legal Business Name): STACY-ANN T THOMAS-LESLIE FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E BALTIMORE PIKE
MEDIA PA
19063-3836
US

IV. Provider business mailing address

503 EMERSON AVE
LANSDOWNE PA
19050-2509
US

V. Phone/Fax

Practice location:
  • Phone: 610-566-3218
  • Fax:
Mailing address:
  • Phone: 610-733-2598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP017443
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSPO32164
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: