Provider Demographics
NPI:1164612735
Name:THOMAS, ERICA MICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MICHELLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 S BECKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8309
Mailing Address - Country:US
Mailing Address - Phone:903-597-7700
Mailing Address - Fax:
Practice Address - Street 1:19432 COUNTY ROAD 2138 STE 200
Practice Address - Street 2:
Practice Address - City:TROUP
Practice Address - State:TX
Practice Address - Zip Code:75789
Practice Address - Country:US
Practice Address - Phone:903-330-3395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX715445163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
715445OtherBOARD OF NURSE EXAMINERS
393611OtherAORN