Individual
ANTONIO TERELL THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMNHP
Contact information
Practice address
6805 STATE ROUTE 162, MARYVILLE, IL 62062-8530
(618) 288-5019
Mailing address
6805 STATE ROUTE 162, MARYVILLE, IL 62062-8530
(618) 288-5019
(618) 288-5059
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041563515
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209034699
IL
Other
Enumeration date
12/18/2025
Last updated
04/23/2026
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