Keldreca Shuntae Thomas, FNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

RN230389 Issued in GA

Practice address

1700 Medical Way
Snellville, GA 30078-2195

Phone

(478) 464-8134

NPI assigned

Jan 26, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H1722

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Columbus Ambulatory Healthcare Services, Inc.

  • Family Medicine Physician
  • Columbus, GA
  • NPI 1790733244
  Medicare reassignment NPD
• Piedmont Athens Hospitalist Physicians LLC

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1578079000
  Medicare reassignment NPD
• Piedmont Hospitalist Physicians LLC

  • Family Medicine Physician
  • Stockbridge, GA
  • NPI 1548219660
  Medicare reassignment NPD
• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Fayetteville, GA
  • NPI 1013313857
  Medicare reassignment NPD
• The Family Health Centers of Georgia, Inc

  dba The Family Health Center at West End

  • Federally Qualified Health Center (FQHC)
  • Atlanta, GA
  • NPI 1720080989
  Medicare reassignment NPD
• Wellness RX Medical Services LLC

  • Nurse Practitioner
  • Atlanta, GA
  • NPI 1932734530
  NPD Authorized official
• Minuteclinic LLC

  • Family Nurse Practitioner
  • Rockville, MD
  • NPI 1134191836

  GA

  Medicare reassignment
• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Savannah, GA
  • NPI 1356907273
  NPD
• The Family Health Centers of Georgia, Inc

  dba McDonough Children's Specialist

  • Federally Qualified Health Center (FQHC)
  • McDonough, GA
  • NPI 1982489555
  NPD
• Columbus Ambulatory Healthcare Services, Inc.

  • Family Medicine Physician
  • Phenix City, AL
  • NPI 1699240531
  NPD
• Piedmont Athens Specialty Care LLC

  • Cardiovascular Disease Physician
  • Athens, GA
  • NPI 1184130627
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1485388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705449600000",
    "number": "1447797600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 W ALAMEDA ST STE 25",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875011673",
            "telephone_number": "505-988-8869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 MEDICAL WAY",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300782195",
            "telephone_number": "478-464-8134"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "868 York Ave SW",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "30310",
            "country_code": "US",
            "telephone_number": "404-752-1400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2429 Martin Luther King Jr Dr SW",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "30311",
            "country_code": "US",
            "telephone_number": "866-389-2727",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "KELDRECA",
        "middle_name": "SHUNTAE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-26",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN230389",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NM",
            "license": "55952",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN230389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Allen Thisdale, M.A., CCC-SLP
• Stephanie Thom, LAPC
• Thomas W. Bantly, M.D., P.C
• Abel Thomas, CPHT
• Cherrell D Thomas, LPC, NCC
• Makyla Elise Thomas
• Mark Shannon Thomas
• Melissa Ann Thomas, RDN, LD, CLC
• Rachel Thomas
• Wilma Thomas, C.R.N.A.

• Psychiatric/Mental Health Nurse Practitioner in Snellville, GA
• Providers in Snellville, GA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.