Provider Demographics
NPI:1710308481
Name:THOMAS, KYAN JENKINS
Entity Type:Individual
Prefix:MRS
First Name:KYAN
Middle Name:JENKINS
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 GAIL DRIVE
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-6338
Mailing Address - Country:US
Mailing Address - Phone:504-343-8292
Mailing Address - Fax:
Practice Address - Street 1:107 GAIL DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-6478
Practice Address - Country:US
Practice Address - Phone:504-343-8292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
LA006638352343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)