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General NPI Number Information
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NPI Number | 1962728915
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Entity Type | Individual
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Provider Name | KISHA DENISE THOMAS MD
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Gender | Female
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 10/22/2018
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Provider Practice Location Address
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Address Line | 7207 GOLDEN WINGS RD STE 100
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City | JACKSONVILLE
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State | FL
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Zip | 32244-3324
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Country | US
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Telephone | 904-389-1010
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Fax | 904-389-1082
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Provider Business Mailing Address
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Address Line | 1100 REID PKWY MEDICAL STAFF SERVICES
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City | RICHMOND
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State | IN
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Zip | 47374-1157
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Country | US
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Telephone | 765-935-8902
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Fax | 765-983-3219
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 01075431A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | ME137547
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License Number State | FL
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