Provider Demographics
NPI:1578755328
Name:THOMAS, PRIYA DAISY (PA)
Entity Type:Individual
Prefix:MRS
First Name:PRIYA
Middle Name:DAISY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:PRIYA
Other - Middle Name:DAISY
Other - Last Name:PHILIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15426 WILDWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325
Mailing Address - Country:US
Mailing Address - Phone:515-438-3265
Mailing Address - Fax:515-438-3631
Practice Address - Street 1:1251 , 334TH STREET
Practice Address - Street 2:WOODWARD RESOURCE CENTER
Practice Address - City:WOODWARD
Practice Address - State:IA
Practice Address - Zip Code:50276
Practice Address - Country:US
Practice Address - Phone:515-438-3265
Practice Address - Fax:515-438-3631
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010623-1363AM0700X
001923363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical