Provider Demographics
NPI:1922796291
Name:THOMAS, CHRISTINE ANN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ANN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4113 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:COHUTTA
Mailing Address - State:GA
Mailing Address - Zip Code:30710-9344
Mailing Address - Country:US
Mailing Address - Phone:706-979-1524
Mailing Address - Fax:
Practice Address - Street 1:1534 IDAHO ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2573
Practice Address - Country:US
Practice Address - Phone:706-979-1524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAN361437092363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health