Healthcare Provider Details

I. General information

NPI: 1508825696
Provider Name (Legal Business Name): KATHLEEN A THOMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 WESTERN HILLS BLVD
CHEYENNE WY
82009-3446
US

IV. Provider business mailing address

123 WESTERN HILLS BLVD
CHEYENNE WY
82009-3446
US

V. Phone/Fax

Practice location:
  • Phone: 307-635-0226
  • Fax: 307-635-1924
Mailing address:
  • Phone: 307-635-0226
  • Fax: 307-635-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number6020A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: