Provider Demographics
NPI:1699135434
Name:THOMAS, LAURA CHRISTINE (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:CHRISTINE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:CHRISTINE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7809 NAVAJOE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-2754
Mailing Address - Country:US
Mailing Address - Phone:314-221-1960
Mailing Address - Fax:
Practice Address - Street 1:4122 KEATON CROSSING BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8218
Practice Address - Country:US
Practice Address - Phone:636-329-9077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016008569363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health