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NPI Code Detail

MEDICARE: KAITLIN MACKENZIE THOMAS NP

MEDICARE: KAITLIN MACKENZIE THOMAS NP
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
1163WE0003XEmergency Registered Nurse28243962AIN
2363LF0000XFamily Nurse Practitioner71014042IN
3363LF0000XFamily Nurse Practitioner71014042AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11103141819OTHERINANTHEM PTAN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881313542
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLIN MACKENZIE THOMAS NP
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1716 HARTFORD STREET
Second Line :
City : LAFAYETTE
State : IN
Zip : 47904-2138
Country : US
Telephone Number : 765-742-1567
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2022
Last Update Date : 10/21/2024

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