Provider Demographics
NPI:1962131987
Name:THOMAS, CHARLETTA ROY
Entity type:Individual
Prefix:
First Name:CHARLETTA
Middle Name:ROY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3419 NW EVANGELINE TRWY # M-7
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-6241
Mailing Address - Country:US
Mailing Address - Phone:337-739-0245
Mailing Address - Fax:
Practice Address - Street 1:3419 NW EVANGELINE TRWY # M-7
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-6241
Practice Address - Country:US
Practice Address - Phone:337-739-0245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health