Provider Demographics
NPI:1003533126
Name:THOMAS, KRISTIE LOUISE (RN)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LOUISE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 S STATE ROUTE 721
Mailing Address - Street 2:
Mailing Address - City:LAURA
Mailing Address - State:OH
Mailing Address - Zip Code:45337-8779
Mailing Address - Country:US
Mailing Address - Phone:937-654-9379
Mailing Address - Fax:
Practice Address - Street 1:4121 S STATE ROUTE 721
Practice Address - Street 2:
Practice Address - City:LAURA
Practice Address - State:OH
Practice Address - Zip Code:45337-8779
Practice Address - Country:US
Practice Address - Phone:937-654-9379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-20
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker