Provider Demographics
NPI:1235935255
Name:THOMAS, PATRICIA MAE
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MAE
Last Name:THOMAS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:BOOMER
Mailing Address - State:WV
Mailing Address - Zip Code:25031-0072
Mailing Address - Country:US
Mailing Address - Phone:304-993-8846
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 72
Practice Address - Street 2:
Practice Address - City:BOOMER
Practice Address - State:WV
Practice Address - Zip Code:25031-0072
Practice Address - Country:US
Practice Address - Phone:304-993-8846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV172V00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker