Provider Demographics
NPI:1740434687
Name:THOMAS, KARIDEE (PA-C, RD)
Entity type:Individual
Prefix:MS
First Name:KARIDEE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA-C, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 159TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6309
Mailing Address - Country:US
Mailing Address - Phone:425-216-0550
Mailing Address - Fax:425-216-0551
Practice Address - Street 1:3925 159TH AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-6309
Practice Address - Country:US
Practice Address - Phone:425-216-0550
Practice Address - Fax:425-216-0551
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005103363A00000X
133V00000X
WAPA 60652684363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered