Provider Demographics
NPI:1790473684
Name:THWAITES, KAY
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:THWAITES
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 1:4121 W IRWIN AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-6087
Mailing Address - Country:US
Mailing Address - Phone:331-219-8125
Mailing Address - Fax:
Practice Address - Street 1:4121 W IRWIN AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6087
Practice Address - Country:US
Practice Address - Phone:331-219-8125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide