MEDICARE: MR. THOMAS ELIAS CUNNINGHAM APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0057700	OK
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	A03250	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578780946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS ELIAS CUNNINGHAM APRN

Provider Business Mailing Address
First Line	:	14801 PARK RIDGE DRIVE
Second Line	:
City	:	LOWELL
State	:	AR
Zip	:	72745
Country	:	US
Telephone Number	:	479-295-6325
Fax Number	:

Provider Business Practice Location Address
First Line	:	5305 W VILLAGE PKWY STE 12
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8116
Country	:	US
Telephone Number	:	479-480-4892
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	09/07/2023

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