Provider Demographics
NPI:1831385442
Name:STROUD, THOMAS SEAN
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:SEAN
Last Name:STROUD
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:SEAN
Other - Middle Name:
Other - Last Name:STROUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2480 MCPHERSON SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MABELVALE
Mailing Address - State:AR
Mailing Address - Zip Code:72103
Mailing Address - Country:US
Mailing Address - Phone:501-847-7838
Mailing Address - Fax:
Practice Address - Street 1:2480 MCPHERSON SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MABELVALE
Practice Address - State:AR
Practice Address - Zip Code:72103
Practice Address - Country:US
Practice Address - Phone:501-847-7838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR61026374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide