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General NPI Number Information
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NPI Number | 1184091894
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Entity Type | Individual
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Provider Name | WYCONDAROGA E THOMAS
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Gender | Female
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 820 ASHLAND AVENUE
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City | GUNNISON
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State | MS
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Zip | 38746
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Country | US
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Telephone | 662-987-5023
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Fax | 662-987-5025
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Provider Business Mailing Address
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Address Line | PO BOX 357
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City | GUNNISON
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State | MS
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Zip | 38746-0357
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Country | US
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Telephone | 662-987-5023
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Fax | 662-987-5023
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R892043
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License Number State | MS
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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 | 35217
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 890243
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 890243
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License Number State | MS
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