Provider Demographics
NPI:1144008269
Name:THOMAS, STEPHANIE SHAE (BSN, RNFA, CNOR)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:SHAE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:BSN, RNFA, CNOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LAYFAIR DR STE 120
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9717
Mailing Address - Country:US
Mailing Address - Phone:601-326-5700
Mailing Address - Fax:601-326-5701
Practice Address - Street 1:1 LAYFAIR DR STE 120
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9717
Practice Address - Country:US
Practice Address - Phone:601-326-5700
Practice Address - Fax:601-326-5701
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS912927163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty