Provider Demographics
NPI:1962498626
Name:THOMAS, WENDY B (CRNA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:B
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CRNA
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:131 TUCKER STREET
Mailing Address - Street 2:SUITE 5 - PROFESSIONAL ANESTHESIA ASSOCIATES
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-4055
Mailing Address - Country:US
Mailing Address - Phone:888-358-0933
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:131 TUCKER STREET
Practice Address - Street 2:SUITE 5 - PROFESSIONAL ANESTHESIA ASSOCIATES
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-4055
Practice Address - Country:US
Practice Address - Phone:731-541-5000
Practice Address - Fax:731-541-7075
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNRN96821163W00000X
TNAPN10965367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3624940Medicaid
TN3624940Medicare PIN
TN3624940Medicare ID - Type Unspecified