MEDICARE: KESHIA THOMAS BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003381518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KESHIA THOMAS BCBA

Provider Business Mailing Address
First Line	:	351 CUMBERLAND HILLS DR
Second Line	:
City	:	MADISON
State	:	TN
Zip	:	37115-2253
Country	:	US
Telephone Number	:	615-669-6397
Fax Number	:

Provider Business Practice Location Address
First Line	:	351 CUMBERLAND HILLS DR
Second Line	:
City	:	MADISON
State	:	TN
Zip	:	37115-2253
Country	:	US
Telephone Number	:	615-669-6397
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2018
Last Update Date	:	10/11/2018

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Directions to “ KESHIA THOMAS BCBA” Practice Location

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