Provider Demographics
NPI:1639978802
Name:THOMAS, VENESSA RENEE (MBA)
Entity type:Individual
Prefix:
First Name:VENESSA
Middle Name:RENEE
Last Name:THOMAS
Suffix:
Gender:
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6628 KIRBY MEADOWS CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-4217
Mailing Address - Country:US
Mailing Address - Phone:901-870-4899
Mailing Address - Fax:
Practice Address - Street 1:6628 KIRBY MEADOWS CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4217
Practice Address - Country:US
Practice Address - Phone:901-870-4899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator