Provider Demographics
NPI:1619512662
Name:THOMAS, MARLISHA LORRAINE
Entity Type:Individual
Prefix:
First Name:MARLISHA
Middle Name:LORRAINE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5577 YARBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-3391
Mailing Address - Country:US
Mailing Address - Phone:662-440-0301
Mailing Address - Fax:469-242-9833
Practice Address - Street 1:7777 FOREST LN STE C833
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2591
Practice Address - Country:US
Practice Address - Phone:972-566-4591
Practice Address - Fax:972-566-6679
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144002363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP144002OtherAPRN
MS894032OtherCOMPACT LICENSE(RN)