Healthcare Provider Details

I. General information

NPI: 1205870029
Provider Name (Legal Business Name): KARAN L THOMAS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S HEALTH PKWY
THREE RIVERS MI
49093-8352
US

IV. Provider business mailing address

701 S HEALTH PKWY MEDICAL STAFF OFFICE
THREE RIVERS MI
49093-8352
US

V. Phone/Fax

Practice location:
  • Phone: 269-278-1145
  • Fax:
Mailing address:
  • Phone: 269-278-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000932
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704160058
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4704160058
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: