Individual
MS. GWENDOLYNN NICOLE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2413 RING RD STE 121, ELIZABETHTOWN, KY 42701-5924
(270) 748-0850
Mailing address
2413 RING RD STE 121, ELIZABETHTOWN, KY 42701-5924
(270) 748-0850
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3007643
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001080865
ANTHEM ID
—
05
—
300009606
—
IN
05
—
7100222860
—
KY
01
—
9228980
AETNA PIN
—
01
—
CS1805200102
CARESOURCE ID
—
Enumeration date
09/28/2012
Last updated
05/06/2026
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