Provider Demographics
NPI:1407415466
Name:JUNKINS, THOMAS L
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:JUNKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7307 GEORGE WASHINGTON MEM HWY # 2-667
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692-4993
Mailing Address - Country:US
Mailing Address - Phone:757-810-0899
Mailing Address - Fax:
Practice Address - Street 1:7307 GEORGE WASHINGTON MEM HWY # 2-667
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692-4993
Practice Address - Country:US
Practice Address - Phone:757-810-0899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001089895163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse