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General NPI Number Information
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NPI Number | 1225816994
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Entity Type | Individual
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Provider Name | EVERLYNE WACERA THOMAS NP
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Gender | Female
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Dates
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Enumeration Date | 09/15/2023
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 4404 N MAIN ST
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City | BAYTOWN
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State | TX
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Zip | 77521-2327
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Country | US
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Telephone | 281-478-9660
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Fax |
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Provider Business Mailing Address
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Address Line | 21327 S KINGS MILL LN
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City | KINGWOOD
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State | TX
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Zip | 77339-1463
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Country | US
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Telephone | 281-235-6652
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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 | F02190757
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License Number State | TX
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