Provider Demographics
NPI:1356796445
Name:THOMAS, RENEE JO (WHNP, AGNP)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:JO
Last Name:THOMAS
Suffix:
Gender:
Credentials:WHNP, AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1708
Mailing Address - Country:US
Mailing Address - Phone:806-414-9650
Mailing Address - Fax:806-354-5730
Practice Address - Street 1:1400 S COULTER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1786
Practice Address - Country:US
Practice Address - Phone:806-414-9650
Practice Address - Fax:806-354-5730
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130421363LA2200X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX359226302Medicaid
NM05909511Medicaid
TX359226301Medicaid
OK200649690 AMedicaid
TX510050YMPMMedicare PIN