Provider Demographics
NPI:1578251757
Name:THOMASON, KAITLYN ALICE (PA-C)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ALICE
Last Name:THOMASON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3084 COUNTY ROAD 2001
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75570-6783
Mailing Address - Country:US
Mailing Address - Phone:903-278-1838
Mailing Address - Fax:
Practice Address - Street 1:1408 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3534
Practice Address - Country:US
Practice Address - Phone:903-614-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16824207Q00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine