Thomas, Sally R

Thomas, Sally R is an individual health care provider with primary practice located at 969 Lakeland Dr , Jackson MS 39216-4606. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Primary Care, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Thomas, Sally R can be contacted via phone (601) 200-6060.

Contact Information

Primary practice address
969 Lakeland Dr Jackson MS 39216-4606
Phone: (601) 200-6060
Fax: (601) 200-6767
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X 904076 Mississippi
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 904076 Mississippi

Profile Details

NPI number 1487244356
LBN Legal business name Thomas, Sally R
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 24th, 2021
Last updated Nov 30th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1487244356 NPPES
Mississippi Other 904076 NP LICENSE NUMBER
Mississippi MEDICAID 00827761 NP LICENSE NUMBER

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