Provider Demographics
NPI:1164311205
Name:THOMAS, JULIE M (PMNHP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PMNHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 LEHMANN RD NW
Mailing Address - Street 2:
Mailing Address - City:ROXIE
Mailing Address - State:MS
Mailing Address - Zip Code:39661-7008
Mailing Address - Country:US
Mailing Address - Phone:601-303-0092
Mailing Address - Fax:
Practice Address - Street 1:149 JEFFERSON ST S STE A
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MS
Practice Address - Zip Code:39654-9400
Practice Address - Country:US
Practice Address - Phone:601-393-1953
Practice Address - Fax:833-449-2018
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS869867363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health