Provider Demographics
NPI:1144782970
Name:THOMAS, KELLY L (LVN)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10011 INK WELLS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-7011
Mailing Address - Country:US
Mailing Address - Phone:903-814-2142
Mailing Address - Fax:
Practice Address - Street 1:10011 INK WELLS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-7011
Practice Address - Country:US
Practice Address - Phone:903-814-2142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX313461208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics