Individual
MARY ROSE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
1488 HWY 487, SEBASTOPOL, MS 39359
(601) 625-7403
(601) 625-7404
Mailing address
PO BOX 150, SEBASTOPOL, MS 39359-0150
(601) 625-7403
(601) 625-7404
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
903412
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04387816
—
MS
Enumeration date
08/21/2019
Last updated
08/06/2020
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