Provider Demographics
NPI:1336454131
Name:THOMAS, BETTY J (PA)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:JEAN
Other - Last Name:MATHISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:12881 N IH 35
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-2966
Mailing Address - Country:US
Mailing Address - Phone:210-742-6555
Mailing Address - Fax:224-623-0079
Practice Address - Street 1:12881 N IH 35
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-2966
Practice Address - Country:US
Practice Address - Phone:210-742-6555
Practice Address - Fax:224-623-0079
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1092887363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant