Provider Demographics
NPI:1528729688
Name:THOMAS, FELICIA R
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5124 PAINTED WOODS CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-2306
Mailing Address - Country:US
Mailing Address - Phone:269-830-4458
Mailing Address - Fax:
Practice Address - Street 1:7629 VALLEY GREEN DR UNIT 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-0350
Practice Address - Country:US
Practice Address - Phone:702-812-5567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-31
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1066071610OtherDRIVERS LICENSR
NV1606071610OtherDRIVERS LICENSE