Provider Demographics
NPI:1770242646
Name:THOMAS, DAPHNE (PMHNP)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MYERS CORNER DR
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-6342
Mailing Address - Country:US
Mailing Address - Phone:540-688-2646
Mailing Address - Fax:540-688-2656
Practice Address - Street 1:25 MYERS CORNER DR
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-6342
Practice Address - Country:US
Practice Address - Phone:540-688-2646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024183570363LP0808X
VA0001314825163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse