Provider Demographics
NPI:1134699218
Name:THEY, MICHAEL (NP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:THEY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 578688
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-8688
Mailing Address - Country:US
Mailing Address - Phone:866-240-8517
Mailing Address - Fax:209-497-8337
Practice Address - Street 1:1608 TULLY RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4031
Practice Address - Country:US
Practice Address - Phone:866-240-8517
Practice Address - Fax:209-497-8337
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95010524363LP0808X, 163WP0000X, 363LF0000X
CA95010524363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily