Individual
KISHA DENISE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7207 GOLDEN WINGS RD STE 100, JACKSONVILLE, FL 32244-3324
(904) 389-1010
(904) 389-1082
Mailing address
1100 REID PKWY, MEDICAL STAFF SERVICES, RICHMOND, IN 47374-1157
(765) 935-8902
(765) 983-3219
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
01075431A
IN
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
ME137547
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000947766
ANTHEM
IN
05
—
201305360
—
IN
Enumeration date
04/15/2010
Last updated
10/22/2018
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