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NPI Code Detail

MEDICARE: KENETA LACHELLE THOMAS APRN, PMHNP

MEDICARE: KENETA LACHELLE THOMAS APRN, PMHNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner3013872KY

General Provider Information

NPI Number : 1710289087
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENETA LACHELLE THOMAS APRN, PMHNP
Provider Business Mailing Address
First Line : 215 E 11TH ST
Second Line :
City : NEWPORT
State : KY
Zip : 41071-2203
Country : US
Telephone Number : 859-655-6100
Fax Number :
Provider Business Practice Location Address
First Line : 215 E 11TH ST
Second Line :
City : NEWPORT
State : KY
Zip : 41071-2203
Country : US
Telephone Number : 859-655-6100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2010
Last Update Date : 08/02/2023

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