Provider Demographics
NPI:1447004882
Name:THOMAS, KELLEY ANNE (RN)
Entity type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:ANNE
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 1:151 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:RESERVE
Mailing Address - State:LA
Mailing Address - Zip Code:70084-5101
Mailing Address - Country:US
Mailing Address - Phone:504-231-8161
Mailing Address - Fax:
Practice Address - Street 1:151 E 28TH ST
Practice Address - Street 2:
Practice Address - City:RESERVE
Practice Address - State:LA
Practice Address - Zip Code:70084-5101
Practice Address - Country:US
Practice Address - Phone:504-231-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN142557163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse