Provider Demographics
NPI:1326255969
Name:THOMAS, DEBORAH V (EDD, APRN, BC)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:V
Last Name:THOMAS
Suffix:
Gender:F
Credentials:EDD, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9509 US HIGHWAY 42 STE 108
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9291
Mailing Address - Country:US
Mailing Address - Phone:502-709-4717
Mailing Address - Fax:502-709-4727
Practice Address - Street 1:9509 US HIGHWAY 42 STE 108
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-9291
Practice Address - Country:US
Practice Address - Phone:502-709-4717
Practice Address - Fax:502-709-4727
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002453363LP0808X, 364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78009164Medicaid