Healthcare Provider Details

I. General information

NPI: 1336068097
Provider Name (Legal Business Name): MRS. PORSCHE THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

362 DEVOE AVE UNIT 473
BRONX NY
10460-9448
US

IV. Provider business mailing address

8225 TROOST AVE
KANSAS CITY MO
64131-3937
US

V. Phone/Fax

Practice location:
  • Phone: 816-642-0641
  • Fax:
Mailing address:
  • Phone: 816-642-0641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14834-T
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: