Provider Demographics
NPI:1538492319
Name:THOMAS, CAROLYN MICHELE (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MICHELE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14406 NE 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-1448
Mailing Address - Country:US
Mailing Address - Phone:800-813-2000
Mailing Address - Fax:
Practice Address - Street 1:3998 VISTA WAY STE 102
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4515
Practice Address - Country:US
Practice Address - Phone:760-631-3056
Practice Address - Fax:760-726-5540
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21554363A00000X
ORPA179141363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KL90Medicare PIN
MDKL90Medicare PIN
CAKL90Medicare PIN