Most Relevant Information
Provider Data
| NPI Number: | 1003339920 |
| Provider Name: | DERICK THOMAS PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | PA2242 |
Most Important Dates
| Enumeration Date: | 07/23/2017 |
| Last Updated: | 07/01/2024 |
Provider Practice Location
2603 KENTUCKY AVE STE 102
PADUCAH
KY
420033815
Practice Location Phone/Fax
| Phone: | 2702283973 |
| Fax: | 2703595046 |
Provider Mailing Location
2603 KENTUCKY AVE STE 102
PADUCAH
KY
420033815
Provider Mailing Phone/Fax
| Phone: | 2702283973 |
| Fax: | 2703595046 |