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General NPI Number Information
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NPI Number | 1225381908
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Entity Type | Individual
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Provider Name | MICKEY D THOMAS FNP-C
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Gender | Male
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Dates
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Enumeration Date | 10/18/2012
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 1701 N LOOP 250 W
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City | MIDLAND
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State | TX
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Zip | 79707-6002
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Country | US
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Telephone | 432-522-5033
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 N LOOP 250 W
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City | MIDLAND
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State | TX
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Zip | 79707-6002
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Country | US
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Telephone | 432-522-5033
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 555867
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License Number State | TX
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