Provider Demographics
NPI:1538469689
Name:THOMAS, CARRICKA D (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CARRICKA
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-3811
Mailing Address - Country:US
Mailing Address - Phone:228-326-9951
Mailing Address - Fax:866-659-9359
Practice Address - Street 1:2300 24TH AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501
Practice Address - Country:US
Practice Address - Phone:228-343-3606
Practice Address - Fax:866-659-9359
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR864120363LF0000X
LA229146363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09032325Medicaid
MS302I507739Medicare PIN