Provider Demographics
NPI:1942419619
Name:THOMAS, SEDRICK
Entity Type:Individual
Prefix:
First Name:SEDRICK
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 SAM RAYBURN TOLLWAY STE 140
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6021
Mailing Address - Country:US
Mailing Address - Phone:469-495-9108
Mailing Address - Fax:
Practice Address - Street 1:975 SAM RAYBURN TOLLWAY STE 140
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6021
Practice Address - Country:US
Practice Address - Phone:469-495-9108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2023-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily