Provider Demographics
NPI:1083331599
Name:THAMES, SELBY REED (CRNA)
Entity Type:Individual
Prefix:MR
First Name:SELBY
Middle Name:REED
Last Name:THAMES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:755 N 11TH ST STE P3600
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1515
Mailing Address - Country:US
Mailing Address - Phone:469-437-3564
Mailing Address - Fax:469-825-6903
Practice Address - Street 1:755 N 11TH ST STE P3600
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1515
Practice Address - Country:US
Practice Address - Phone:469-437-3564
Practice Address - Fax:469-825-6903
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP1108303367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered