Provider Demographics
NPI:1164624664
Name:THOMAS, TRISTA LEE (CST)
Entity Type:Individual
Prefix:MS
First Name:TRISTA
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3328 KUEBLER RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47720-7412
Mailing Address - Country:US
Mailing Address - Phone:812-963-8335
Mailing Address - Fax:812-402-2139
Practice Address - Street 1:4501 UPPER MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-6421
Practice Address - Country:US
Practice Address - Phone:812-421-8555
Practice Address - Fax:812-402-2139
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN066064246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist