Individual
KELLY THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2901 BRIDGEPORT WAY W, UNIVERSITY PLACE, WA 98466-4614
(253) 241-4176
Mailing address
15324 68TH AVENUE CT E, PUYALLUP, WA 98375-7121
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP00059430
WA
Other
Enumeration date
05/08/2025
Last updated
05/08/2025
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