Tommy Lee Provost

Primary specialty

ContractorTaxonomy code 171W00000X

Practice address

5832 Midnight LN
Grand Prairie, TX 75052-8585

Phone

(682) 465-5267

NPI assigned

Aug 17, 2015

Last updated

Aug 17, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1439769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439769600000",
    "number": "1396111019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5832 MIDNIGHT LN",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750528585",
            "telephone_number": "682-465-5267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5832 MIDNIGHT LN",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750528585",
            "telephone_number": "682-465-5267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVOST",
        "first_name": "TOMMY",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-08-17",
        "last_updated": "2015-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Contractor in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Contractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.