Individual
WYCONDAROGA E THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
820 ASHLAND AVENUE, GUNNISON, MS 38746
(662) 987-5023
(662) 987-5025
Mailing address
PO BOX 357, GUNNISON, MS 38746-0357
(662) 987-5023
(662) 987-5023
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
35217
TN
363LF0000X
Family Nurse Practitioner
Primary
890243
MS
363LF0000X
Family Nurse Practitioner
R892043
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
890243
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04784050
—
MS
Enumeration date
08/28/2015
Last updated
06/16/2025
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