Healthcare Provider Details

I. General information

NPI: 1891849485
Provider Name (Legal Business Name): KATHLEEN G. THOMAS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 POTTERY AVE
PORT ORCHARD WA
98366-3711
US

IV. Provider business mailing address

PO BOX 34584
SEATTLE WA
98124-1584
US

V. Phone/Fax

Practice location:
  • Phone: 360-895-5000
  • Fax:
Mailing address:
  • Phone: 509-241-7349
  • Fax: 509-241-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberPA10003079
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: