Basic Information
| Provider Information | |||||||||
| NPI: | 1356079875 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | MISTY | ||||||||
| MiddleName: | DANIELE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2777 POSSUM TROT RD | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287145749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282843094 | ||||||||
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| Practice Location | |||||||||
| Address1: | 590 MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287536807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286493500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2022 | ||||||||
| LastUpdateDate: | 08/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5016669 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.