=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649419334
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LESIA THOMAS FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2009
-----------------------------------------------------
Last Update Date | 10/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1911 MISSION 66 STE B
-----------------------------------------------------
City | VICKSBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39180-3762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-456-2598
-----------------------------------------------------
Fax | 855-830-3484
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 KATHERINE DR STE A
-----------------------------------------------------
City | FLOWOOD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39232-9588
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-665-4162
-----------------------------------------------------
Fax | 888-398-1151
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R740023
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------