Healthcare Provider Details

I. General information

NPI: 1669952354
Provider Name (Legal Business Name): ROGER DUANE THOMAS PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N LOCUST AVE
LAWRENCEBURG TN
38464-3757
US

IV. Provider business mailing address

200 TECH CENTER DR
KNOXVILLE TN
37912-2747
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-7232
  • Fax: 931-762-7234
Mailing address:
  • Phone: 865-637-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24628
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4046751
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number24628
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: