Provider Demographics
NPI:1669914313
Name:THOMAS, BEENA (FNP)
Entity type:Individual
Prefix:MRS
First Name:BEENA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:BEENA
Other - Middle Name:KAZHUTHADIYIL
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3939 7TH STREET RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4103
Mailing Address - Country:US
Mailing Address - Phone:502-883-6800
Mailing Address - Fax:502-384-2316
Practice Address - Street 1:3939 7TH STREET RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4103
Practice Address - Country:US
Practice Address - Phone:502-883-6800
Practice Address - Fax:502-384-2316
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-12
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily