Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP143022 | TX |
NPI | 1083264808 |
---|---|
Provider Name | Ashlyn Elyse Thom |
First Address | Katy, TX 77494-2169 |
Second Address | Katy, TX 77494-7267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2019 |
Last Update Date | 15/10/2019 |