Individual
SALLY R THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-6060
(601) 200-6767
Mailing address
PO BOX 23457, JACKSON, MS 39225-3457
(601) 200-6060
(601) 200-6767
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
904076
MS
363LP2300X
Primary Care Nurse Practitioner
904076
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00827761
—
MS
01
—
904076
NP LICENSE NUMBER
MS
Enumeration date
01/24/2021
Last updated
11/30/2021
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