Provider Demographics
NPI:1003041534
Name:CHURCH, THOMAS GARY (FNPBC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GARY
Last Name:CHURCH
Suffix:
Gender:
Credentials:FNPBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 HICKORY BLVD.
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28638
Mailing Address - Country:US
Mailing Address - Phone:828-386-1001
Mailing Address - Fax:828-358-1317
Practice Address - Street 1:2990 HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NC
Practice Address - Zip Code:28638
Practice Address - Country:US
Practice Address - Phone:828-386-1001
Practice Address - Fax:828-358-1317
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC184774363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner