Provider Demographics
NPI:1003241308
Name:THOMAS, KAMISHIA LATASHA (ANP-C)
Entity Type:Individual
Prefix:
First Name:KAMISHIA
Middle Name:LATASHA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 S. STATE STREET
Mailing Address - Street 2:MAIL CODE 3055
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901
Mailing Address - Country:US
Mailing Address - Phone:302-480-1688
Mailing Address - Fax:302-480-9807
Practice Address - Street 1:200 BANNING ST STE 340
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3490
Practice Address - Country:US
Practice Address - Phone:302-734-1414
Practice Address - Fax:302-734-2121
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELP-0010630363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1003241308Medicaid
SCNP2568Medicaid
NC1003241308Medicaid