Provider Demographics
NPI:1760153126
Name:VINING, THAO T (NP)
Entity Type:Individual
Prefix:
First Name:THAO
Middle Name:T
Last Name:VINING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 MATLOCK RD STE 160
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76002-4806
Mailing Address - Country:US
Mailing Address - Phone:817-678-6449
Mailing Address - Fax:
Practice Address - Street 1:8200 MATLOCK RD STE 160
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76002-4806
Practice Address - Country:US
Practice Address - Phone:817-678-6449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP1057176363L00000X
TX1057176363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner