Provider Demographics
NPI:1265715254
Name:THOMAS, TIA D (FNP-C)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:D
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:THOMAS-WALTON
Mailing Address - Street 1:1701 OLD MINDEN RD STE 17F
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-4804
Mailing Address - Country:US
Mailing Address - Phone:318-317-1238
Mailing Address - Fax:
Practice Address - Street 1:1701 OLD MINDEN RD STE 17F
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-4804
Practice Address - Country:US
Practice Address - Phone:318-317-1238
Practice Address - Fax:318-390-1800
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX807424363LF0000X
LAAP06652363LF0000X
TXAP120792363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily