MEDICARE: MRS. NANCY L THOMAS APN

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	363LP0200X	Pediatric Nurse Practitioner	A01320	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	:	1801102702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY L THOMAS APN

Provider Business Mailing Address
First Line	:	2301 SPRINGHILL RD STE 200
Second Line	:
City	:	BRYANT
State	:	AR
Zip	:	72019-7566
Country	:	US
Telephone Number	:	501-315-0078
Fax Number	:	501-943-3016

Provider Business Practice Location Address
First Line	:	2301 SPRINGHILL RD STE 200
Second Line	:
City	:	BRYANT
State	:	AR
Zip	:	72019-7566
Country	:	US
Telephone Number	:	501-315-0078
Fax Number	:	501-943-3016

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

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	12/03/2012

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