Brenda Thomas
Individual provider Active NPI Contractor · Flowood, MS
NPI 1316403173 · NPPES record last updated Feb 18, 2019
Key facts
- NPI
- 1316403173
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 7482316 (MS)
- Practice address
- 1005 Laurel Dr
Flowood, MS 39232-8342 - Phone
- (601) 613-5947
- NPI assigned
- Feb 18, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7482316 | MS | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 7482316 | MS | Yes |
Addresses
Primary practice location
1005 Laurel Dr
Flowood, MS 39232-8342
Mailing address
1005 Laurel Dr
Flowood, MS 39232-8342
Phone (601) 613-5947
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7482316 | Other | MS | NPN |
Other providers in Flowood, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.