Provider Demographics
NPI:1679870851
Name:THOMAS, SUSAN LYNN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LYNN
Last Name:THOMAS
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 1:6211 W NORTHWEST HWY
Mailing Address - Street 2:SUITE C255
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-3460
Mailing Address - Country:US
Mailing Address - Phone:972-292-7158
Mailing Address - Fax:
Practice Address - Street 1:6211 W NORTHWEST HWY
Practice Address - Street 2:SUITE C255
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-3460
Practice Address - Country:US
Practice Address - Phone:972-292-7158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX639649363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX263169YKY6Medicare PIN