Provider Demographics
NPI:1104245588
Name:THOMAS, VIRGINIA TAMMY (APRN)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:TAMMY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 SW 89TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7901
Mailing Address - Country:US
Mailing Address - Phone:405-427-3705
Mailing Address - Fax:405-427-3738
Practice Address - Street 1:3115 SW 89TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7901
Practice Address - Country:US
Practice Address - Phone:405-427-3705
Practice Address - Fax:405-427-3738
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK88125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily