Healthcare Provider Details

I. General information

NPI: 1952280760
Provider Name (Legal Business Name): CRYSTAL GAYLE THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 MEYERS BAKER RD STE 200
LONDON KY
40741-3040
US

IV. Provider business mailing address

803 MEYERS BAKER RD STE 200
LONDON KY
40741-3040
US

V. Phone/Fax

Practice location:
  • Phone: 606-878-3240
  • Fax: 606-878-3244
Mailing address:
  • Phone: 606-878-3240
  • Fax: 606-878-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4045967
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: