Provider Demographics
NPI:1386683415
Name:THOMAS, MARY ANNE (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 OLD CORYDON RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-4645
Mailing Address - Country:US
Mailing Address - Phone:270-826-0200
Mailing Address - Fax:270-826-0212
Practice Address - Street 1:452 OLD CORYDON RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-4645
Practice Address - Country:US
Practice Address - Phone:270-826-0200
Practice Address - Fax:270-826-0212
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001791A363L00000X
KY3005374363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q30797Medicare UPIN