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General NPI Number Information
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NPI Number | 1518072586
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Entity Type | Individual
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Provider Name | ASHLEY MARIE THOMANN PA
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Gender | Female
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 05/11/2018
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Provider Practice Location Address
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Address Line | 1800 W UNIVERSITY BLVD
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City | DURANT
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State | OK
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Zip | 74701-3006
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Country | US
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Telephone | 580-924-3080
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Fax |
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Provider Business Mailing Address
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Address Line | 75 YELLOWBRICK RD
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City | DURANT
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State | OK
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Zip | 74701-5087
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Country | US
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Telephone | 214-274-9837
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA04385
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1831
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License Number State | OK
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