Healthcare Provider Details

I. General information

NPI: 1821564378
Provider Name (Legal Business Name): CASEY LEAH THOMAS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7719 HIGHWAY 131
WASHBURN TN
37888-4055
US

IV. Provider business mailing address

1923 SULPHUR SPRINGS RD
MORRISTOWN TN
37813-5654
US

V. Phone/Fax

Practice location:
  • Phone: 865-497-2591
  • Fax: 865-497-3803
Mailing address:
  • Phone: 423-317-9344
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number70076
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: