Tomieko Threadgill, PHLEBO, MA, CMLA

Primary specialty

Phlebotomy TechnicianTaxonomy code 246RP1900X

License

279306 Issued in MS

Practice address

549 E Pass Rd Ste J
Gulfport, MS 39507-3261

Phone

(228) 284-4176

Fax

(228) 284-5724

NPI assigned

Jun 30, 2020

Last updated

Jul 22, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

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

• Fairy Wings Mobile Phlebotomy Service LLC

  dba Fairy Wings Laboratory and Specialty Services

  • Health Service Clinic/Center
  • Gulfport, MS
  • NPI 1316517329
  Authorized official Same address or phone

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

{
    "created_epoch": "1593475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1972120525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "549 E PASS RD STE J",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395073261",
            "telephone_number": "228-284-4176",
            "fax_number": "228-284-5724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "549 E PASS RD STE J",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395073261",
            "telephone_number": "228-284-4176",
            "fax_number": "228-284-5724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THREADGILL",
        "first_name": "TOMIEKO",
        "name_prefix": "Ms.",
        "credential": "PHLEBO, MA, CMLA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-30",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374700000X",
            "taxonomy_group": "",
            "desc": "Technician",
            "state": "MS",
            "license": "279306",
            "primary": false
        },
        {
            "code": "246RP1900X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Phlebotomy",
            "state": "MS",
            "license": "279306",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MS",
            "license": "25D2232943",
            "primary": false
        },
        {
            "code": "246RM2200X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Medical Laboratory",
            "state": "MS",
            "license": "279306",
            "primary": false
        },
        {
            "code": "247ZC0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician, Pathology, Clinical Laboratory Director, Non-physician",
            "state": "MS",
            "license": "25D2232943",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002200921",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Phlebotomy Technician in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Phlebotomy Technician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2024; 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.