Provider Demographics
NPI:1336919828
Name:THOMAS, BRECKEN NATHANIEL
Entity type:Individual
Prefix:MR
First Name:BRECKEN
Middle Name:NATHANIEL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8017 STATE ROUTE 503
Mailing Address - Street 2:
Mailing Address - City:ARGILLITE
Mailing Address - State:KY
Mailing Address - Zip Code:41121-8616
Mailing Address - Country:US
Mailing Address - Phone:606-315-6969
Mailing Address - Fax:
Practice Address - Street 1:8017 STATE ROUTE 503
Practice Address - Street 2:
Practice Address - City:ARGILLITE
Practice Address - State:KY
Practice Address - Zip Code:41121-8616
Practice Address - Country:US
Practice Address - Phone:606-315-6969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant