Individual
KAITLIN MACKENZIE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1716 HARTFORD STREET, LAFAYETTE, IN 47904-2138
(765) 742-1567
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
28243962A
IN
363LF0000X
Family Nurse Practitioner
71014042
IN
363LF0000X
Family Nurse Practitioner
Primary
71014042A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1103141819
ANTHEM PTAN
IN
05
—
300079248
—
IN
Enumeration date
08/25/2022
Last updated
10/21/2024
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