Provider Demographics
NPI:1225449788
Name:THOMAS, LATHA MATHEW (RN,FNP)
Entity Type:Individual
Prefix:MRS
First Name:LATHA
Middle Name:MATHEW
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 CREEKVISTA CT
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-6869
Mailing Address - Country:US
Mailing Address - Phone:817-993-0293
Mailing Address - Fax:
Practice Address - Street 1:3529 HERITAGE TRACE PKWY STE 137
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4971
Practice Address - Country:US
Practice Address - Phone:817-741-7570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-17
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125392164W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX355496YKPWMedicare PIN