Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Theerarat Thanavaro

Individual provider Adult Health Nurse Practitioner · NPI 1265823074

Theerarat Thanavaro is a Nurse Practitioner in Parkville, Maryland. Qualified in 2013, 13 years ago. Practices with SSM Medical Group Inc, a 560-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Missouri.

Years since qualifying
13
Licensed in
MO
In the registry since
2015

Practice location Address checks out

9512 Harford Rd
Parkville, MD 21234-3100
Phone: (410) 665-4400
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 300 Medical Plz Ste 150, Lake St Louis, MO 63367-1483 — (636) 625-2662

Specialties & licences

Adult Health Nurse Practitioner (primary) Taxonomy 363LA2200X · Licence 2014015283 (MO)

Record details

NPI number1265823074
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedFebruary 16, 2015
Last updated in NPPESNovember 24, 2020
Certification dateNovember 24, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Ssm Medical Group Inc — 560 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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