=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407533946
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHA THOMAS AGACNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2023
-----------------------------------------------------
Last Update Date | 07/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1327 LAKE POINTE PKWY
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478-4095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-798-3520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31014 PECAN CREEK DR
-----------------------------------------------------
City | BROOKSHIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77423-2672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-779-8299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 1126175
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------