Provider Demographics
NPI:1609195072
Name:THOMASON, THERA SUMNER (FNP)
Entity Type:Individual
Prefix:
First Name:THERA
Middle Name:SUMNER
Last Name:THOMASON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 N VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-3902
Mailing Address - Country:US
Mailing Address - Phone:423-255-5313
Mailing Address - Fax:
Practice Address - Street 1:201 E 10TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH PITTSBURG
Practice Address - State:TN
Practice Address - Zip Code:37380-1497
Practice Address - Country:US
Practice Address - Phone:901-765-3110
Practice Address - Fax:901-765-3106
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNF0310200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily