Provider Demographics
NPI:1396513685
Name:THOMAS, KATHERINE KRISTEN
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:KRISTEN
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 1:9852 WEATHER STONE PL
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-6779
Mailing Address - Country:US
Mailing Address - Phone:239-849-8214
Mailing Address - Fax:
Practice Address - Street 1:9852 WEATHER STONE PL
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-6779
Practice Address - Country:US
Practice Address - Phone:239-849-8214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9118053363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant