Basic Information
| Provider Information | |||||||||
| NPI: | 1144620113 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SKINNER | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | EDISON | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MSN, ACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 619 19TH ST S | ||||||||
| Address2: | NP 5240 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352496836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059344206 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1802 6TH AVE S | ||||||||
| Address2: | 5240 NORTH PAVILION | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352331932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059344206 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2014 | ||||||||
| LastUpdateDate: | 10/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 1-131236 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.