Provider Demographics
NPI:1235998048
Name:THOMAS, KEVIN NATHINEAL SR
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:NATHINEAL
Last Name:THOMAS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:517 55TH ST NE APT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-6729
Mailing Address - Country:US
Mailing Address - Phone:202-894-5413
Mailing Address - Fax:
Practice Address - Street 1:517 55TH ST NE APT 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6729
Practice Address - Country:US
Practice Address - Phone:202-894-5413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC376K00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant