1598419863 NPI number — KENISHA THOMAS NP LLCO

Table of content: (NPI 1598419863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598419863 NPI number — KENISHA THOMAS NP LLCO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENISHA THOMAS NP LLCO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598419863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2764 N GREEN VALLEY PKWY # 469
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89014-2120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 GALLERIA BLVD STE 1900
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70001-7553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-583-3230
Provider Business Practice Location Address Fax Number:
763-402-7649
Provider Enumeration Date:
02/07/2022

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
KENISHA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
504-610-5194

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1609359165 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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