Provider Demographics
NPI:1770344566
Name:THOMAS, ERIC SR (APRN)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:THOMAS
Suffix:SR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5124 CONGO RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-1752
Mailing Address - Country:US
Mailing Address - Phone:501-317-1117
Mailing Address - Fax:
Practice Address - Street 1:6640 CONGO RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-6913
Practice Address - Country:US
Practice Address - Phone:501-794-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR218942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily