Healthcare Provider Details

I. General information

NPI: 1295309615
Provider Name (Legal Business Name): KRISTEN M THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 N CHURCH ST- ENTRANCE A
GREENSBORO NC
27401
US

IV. Provider business mailing address

10756 PARK SPRINGS RD
RUFFIN NC
27326-8802
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-2546
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3404132
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: