Provider Demographics
NPI:1508409145
Name:FACIAL EXPRESSIONS PRESENTED BY K. THOMAS
Entity Type:Organization
Organization Name:FACIAL EXPRESSIONS PRESENTED BY K. THOMAS
Other - Org Name:FACIAL EXPRESSIONS MEDSPA & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NP/ BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:504-610-5194
Mailing Address - Street 1:2764 N GREEN VALLEY PKWY # 469
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1485 W WARM SPRINGS RD STE 109-B
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-7631
Practice Address - Country:US
Practice Address - Phone:702-482-9980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-27
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No251F00000XAgenciesHome Infusion
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1609359165Medicaid
NV250006009Medicaid