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General NPI Number Information
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NPI Number | 1023993508
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Entity Type | Individual
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Provider Name | TYSON W THOMAS APRN, FNP-C
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Gender | Male
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 1840 S 1300 E
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City | SALT LAKE CITY
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State | UT
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Zip | 84105-3617
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Country | US
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Telephone | 208-970-9522
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Fax |
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Provider Business Mailing Address
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Address Line | 1840 S 1300 E
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City | SALT LAKE CITY
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State | UT
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Zip | 84105-3617
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11857997-4405
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11857997-4405
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License Number State | UT
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