Provider Demographics
NPI:1104004043
Name:THOMAS, CAROLYN MARIE (RD,LD)
Entity Type:Individual
Prefix:MISS
First Name:CAROLYN
Middle Name:MARIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:BOICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3008 W HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-7527
Mailing Address - Country:US
Mailing Address - Phone:615-306-0294
Mailing Address - Fax:
Practice Address - Street 1:950 BRECKENRIDGE LN STE 10
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5931
Practice Address - Country:US
Practice Address - Phone:502-894-9499
Practice Address - Fax:502-894-9595
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2075133V00000X
TN1685133V00000X
KY124752133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered