Provider Demographics
NPI:1578894044
Name:THOMAS, KATHRYN J (RN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1563 S 2250 E
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-8420
Mailing Address - Country:US
Mailing Address - Phone:801-830-9489
Mailing Address - Fax:
Practice Address - Street 1:750 N 200 W
Practice Address - Street 2:SUITE 300
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1677
Practice Address - Country:US
Practice Address - Phone:801-373-4760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-24
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT193656-3102163W00000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse