MEDICARE: MARY CAROLYN THOMAS ARNP

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	363LF0000X	Family Nurse Practitioner	2025P	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811004831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CAROLYN THOMAS ARNP

Provider Business Mailing Address
First Line	:	801 BARRET AVE STE 210
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1733
Country	:	US
Telephone Number	:	502-587-0111
Fax Number	:	502-587-9112

Provider Business Practice Location Address
First Line	:	801 BARRET AVE STE 210
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40204-1733
Country	:	US
Telephone Number	:	502-587-0111
Fax Number	:	502-587-9112

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	09/26/2007

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