Provider Demographics
NPI:1740683598
Name:THOMAS, KATHLEEN A (RN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 SHROYER RD
Mailing Address - Street 2:KETTERING FAIRMONT HIGH SCHOOL
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429
Mailing Address - Country:US
Mailing Address - Phone:937-499-1653
Mailing Address - Fax:937-499-1717
Practice Address - Street 1:3750 FAR HILLS AVE
Practice Address - Street 2:KETTERING CITY SCHOOLS
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429
Practice Address - Country:US
Practice Address - Phone:937-499-1458
Practice Address - Fax:937-499-1717
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN274810163W00000X
OHOH1213211163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WS0200XNursing Service ProvidersRegistered NurseSchool