Provider Demographics
NPI:1073989158
Name:THOMAS, KELLY (CNP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
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Mailing Address - Street 1:5855 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2269
Mailing Address - Country:US
Mailing Address - Phone:419-824-7407
Mailing Address - Fax:419-824-7359
Practice Address - Street 1:2121 HUGHES DR
Practice Address - Street 2:SUITE 640
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3845
Practice Address - Country:US
Practice Address - Phone:419-291-2207
Practice Address - Fax:419-479-6998
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH3833521363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner