Healthcare Provider Details

I. General information

NPI: 1932034931
Provider Name (Legal Business Name): KIMBERLY ANNE THOMAS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4467 JOHNSON RD
BEMUS POINT NY
14712-9748
US

IV. Provider business mailing address

4467 JOHNSON RD
BEMUS POINT NY
14712-9748
US

V. Phone/Fax

Practice location:
  • Phone: 716-397-9521
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number594707
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: