Basic Information
| Provider Information | |||||||||
| NPI: | 1750857769 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | BONE | ||||||||
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| Credential: | PMHNP-BC, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 557 GRANTS FERRY RD | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390479023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016654162 | ||||||||
| FaxNumber: | 8558303484 | ||||||||
| Practice Location | |||||||||
| Address1: | 1911 MISSION 66 STE B | ||||||||
| Address2: | |||||||||
| City: | VICKSBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391803762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016654162 | ||||||||
| FaxNumber: | 8558303484 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2018 | ||||||||
| LastUpdateDate: | 09/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 902984 | MS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 902984 | MS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0808X | 902984 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 2018069079 | 01 | MS | APRN | OTHER | 01833256 | 05 | MS | MEDICAID |