Individual
MINI THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4000
(713) 745-4516
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(281) 948-8605
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
AP132159
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
391629801
—
TX
01
—
391629802
MEDICAID CSHCN
TX
Enumeration date
07/26/2018
Last updated
02/11/2019
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