Provider Demographics
NPI:1689008401
Name:THOMAS, CAROLYN ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1869 HIGHWAY 45 BYP
Mailing Address - Street 2:SUITE 5
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2464
Mailing Address - Country:US
Mailing Address - Phone:469-547-3233
Mailing Address - Fax:731-668-0380
Practice Address - Street 1:1869 HIGHWAY 45 BYP
Practice Address - Street 2:SUITE 5
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2464
Practice Address - Country:US
Practice Address - Phone:469-547-3233
Practice Address - Fax:731-668-0380
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45266164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse