Roberta Lynne Thomas, PHD, RN, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4704213427 Issued in MI

Practice address

300 68TH St SE
Grand Rapids, MI 49548-6927

Phone

(616) 281-6315

Fax

(616) 455-5370

NPI assigned

Jan 18, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Doctor of Philosophy, Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pine Rest Christian Mental Health Services

  • Nurse Practitioner
  • Grand Rapids, MI
  • NPI 1467463604
  Medicare reassignment NPD
• Pine Rest Christian Mental Health Services

  • Professional Counselor
  • Grand Rapids, MI
  • NPI 1386015683
  NPD

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

{
    "created_epoch": "1358467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387324800000",
    "number": "1740528165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-455-5000",
            "fax_number": "616-455-5960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-281-6315",
            "fax_number": "616-455-5370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "ROBERTA",
        "middle_name": "LYNNE",
        "name_prefix": "Ms.",
        "credential": "PHD, RN, NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-18",
        "last_updated": "2013-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704213427",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704213427",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lince Thomas, PHARMD
• Megan Miriam Thomas, DO
• Natalie Judy Thomas
• Nicholas Thomas
• Nicole Thomas, CTRS
• Thomcy Mary Thomas, M.A., LLPC
• Treg Allen Thomas, PSY.D.
• Wanda Thomas
• Yuliya Thomas, CRNA
• Thomas. J. Burdo, DDS

• Psychiatric/Mental Health Nurse Practitioner in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.