Provider Demographics
NPI:1184971046
Name:THOMAS, RHONDA JOYCE (FNP-C, ACNP)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:JOYCE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP-C, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MS
Mailing Address - Zip Code:39654-7703
Mailing Address - Country:US
Mailing Address - Phone:601-250-4366
Mailing Address - Fax:
Practice Address - Street 1:1065 E BROAD ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MS
Practice Address - Zip Code:39654-7703
Practice Address - Country:US
Practice Address - Phone:601-587-4051
Practice Address - Fax:601-587-1256
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR875690363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04802591Medicaid