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General NPI Number Information
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NPI Number | 1346484011
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Entity Type | Individual
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Provider Name | SYLVIA GRACE THOMAS ANP
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Gender | Female
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Dates
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Enumeration Date | 04/26/2009
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Last Update Date | 03/01/2011
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Provider Practice Location Address
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Address Line | 3400 W TRUMAN BLVD
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-5712
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Country | US
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Telephone | 573-632-2777
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Fax | 573-632-2769
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Provider Business Mailing Address
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Address Line | 3349 AMERICAN AVE STE C
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-1080
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Country | US
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Telephone | 573-632-2777
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Fax | 573-632-2769
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 120727
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | NOT YET AVAILABLE
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License Number State | MO
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