MEDICARE: MR. THOMAS MALONEY HARKINS III NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	908143	MS
2	363LG0600X	Gerontology Nurse Practitioner	908143	MS
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1184574451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS MALONEY HARKINS III NP

Provider Business Mailing Address
First Line	:	5959 S SHERWOOD FOREST BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6038
Country	:	US
Telephone Number	:	601-200-2780
Fax Number	:	225-765-9196

Provider Business Practice Location Address
First Line	:	971 LAKELAND DR STE 657
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4608
Country	:	US
Telephone Number	:	601-200-2780
Fax Number	:	601-200-2788

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2026
Last Update Date	:	02/11/2026

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