Provider Demographics
NPI:1730172396
Name:THOMAS, ANGELA D (APRN)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:D
Other - Last Name:LEICHTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:13111 EASTPOINT PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4164
Mailing Address - Country:US
Mailing Address - Phone:502-443-9962
Mailing Address - Fax:844-300-5176
Practice Address - Street 1:13111 EASTPOINT PARK BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4164
Practice Address - Country:US
Practice Address - Phone:502-443-9962
Practice Address - Fax:844-300-5176
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78008455Medicaid
3003864OtherKENTUCKY APRN LICENSE
3003864OtherKENTUCKY APRN LICENSE
KY2440608000OtherPASSPORT ADVANTAGE
KYP70465Medicare UPIN
KY0225912Medicare PIN
KY500030209OtherRAILROAD MEDICARE
KY5005028OtherPASSPORT
KY7535402OtherAETNA