Provider Demographics
NPI:1689345076
Name:THOMAS, LACHELSIE NICOLE (PA)
Entity Type:Individual
Prefix:
First Name:LACHELSIE
Middle Name:NICOLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2284 ASHLEY RIVER RD APT 103
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-4766
Mailing Address - Country:US
Mailing Address - Phone:864-906-0625
Mailing Address - Fax:
Practice Address - Street 1:1064 GARDNER RD STE 105-106
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5768
Practice Address - Country:US
Practice Address - Phone:854-429-1175
Practice Address - Fax:843-695-9467
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-11782363A00000X
SC4133363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant