MEDICARE: MRS. KYAN JENKINS THOMAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)		LA
2	343900000X	Non-emergency Medical Transport (VAN)	006638352	LA

General Provider Information

NPI Number	:	1710308481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KYAN JENKINS THOMAS

Provider Business Mailing Address
First Line	:	107 GAIL DRIVE
Second Line	:
City	:	LA PLACE
State	:	LA
Zip	:	70068-6338
Country	:	US
Telephone Number	:	504-343-8292
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 GAIL DR
Second Line	:
City	:	LA PLACE
State	:	LA
Zip	:	70068-6478
Country	:	US
Telephone Number	:	504-343-8292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2013
Last Update Date	:	07/21/2022

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