Provider Demographics
NPI:1801102702
Name:THOMAS, NANCY L (APN)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 SPRINGHILL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72019-7566
Mailing Address - Country:US
Mailing Address - Phone:501-315-0078
Mailing Address - Fax:501-943-3016
Practice Address - Street 1:2301 SPRINGHILL RD STE 200
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72019-7566
Practice Address - Country:US
Practice Address - Phone:501-315-0078
Practice Address - Fax:501-943-3016
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01320363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1801102702Medicaid