Provider Demographics
NPI:1821150426
Name:THOMAS, KATHALEEN L (FNP)
Entity Type:Individual
Prefix:
First Name:KATHALEEN
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATHALEEN
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:350 COMMERCE SQ
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3376
Mailing Address - Country:US
Mailing Address - Phone:219-872-9158
Mailing Address - Fax:
Practice Address - Street 1:10176 W 400 N STE C
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9009
Practice Address - Country:US
Practice Address - Phone:219-873-1777
Practice Address - Fax:219-873-0001
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28127434A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily