Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP08842 | LA |
NPI | 1003267576 |
---|---|
Provider Name | Stephanie Thomas |
First Address | Baton Rouge, LA 70816-6038 |
Second Address | Plaquemine, LA 70764-6553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2016 |
Last Update Date | 07/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
048607 | CDS (01) | LA |
2433636 | (05) | LA |
AP08842 | STATE LICENSE (01) | LA |
MT3954915 | DEA (01) | LA |