Provider Demographics
NPI:1487167128
Name:THOMAS, CARLA CHARLENE
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:CHARLENE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CARLA
Other - Middle Name:CHARLENE
Other - Last Name:NICHOLS (MAIDEN)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 46
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:WV
Mailing Address - Zip Code:26320
Mailing Address - Country:US
Mailing Address - Phone:304-758-5198
Mailing Address - Fax:
Practice Address - Street 1:164 KLONDIKE RD (PHYSICAL)
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:WV
Practice Address - Zip Code:26320
Practice Address - Country:US
Practice Address - Phone:304-758-5198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0032643000OtherPROVIDER I.D.