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NPI Code Detail

MEDICARE: MRS. LATHA MATHEW THOMAS RN,FNP

MEDICARE: MRS. LATHA MATHEW THOMAS RN,FNP
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
1164W00000XLicensed Practical NurseAP125392TX
2363LF0000XFamily Nurse PractitionerAP125392TX

General Provider Information

NPI Number : 1225449788
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LATHA MATHEW THOMAS RN,FNP
Provider Business Mailing Address
First Line : 1609 CREEKVISTA CT
Second Line :
City : KELLER
State : TX
Zip : 76248-6869
Country : US
Telephone Number : 817-993-0293
Fax Number :
Provider Business Practice Location Address
First Line : 3529 HERITAGE TRACE PKWY STE 137
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-4971
Country : US
Telephone Number : 817-741-7570
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2014
Last Update Date : 02/26/2022

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