Provider Demographics
NPI:1811553688
Name:THOMAS, KELSEY B'ANCA
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:B'ANCA
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 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5426
Mailing Address - Fax:
Practice Address - Street 1:321 5TH AVE W
Practice Address - Street 2:
Practice Address - City:CRESCO
Practice Address - State:IA
Practice Address - Zip Code:52136-1245
Practice Address - Country:US
Practice Address - Phone:563-547-2022
Practice Address - Fax:563-547-3448
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-50218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine