Individual provider Active NPI

Lachelsie Nicole Thomas, PA

  • Physician Assistant
  • Charleston, SC
National Provider Identifier
1689345076
Registry record updated Jul 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4133 Issued in SC
Practice address
1064 Gardner Rd Ste 105-106
Charleston, SC 29407-5768
Phone
(854) 429-1175
Fax
(843) 695-9467
NPI assigned
Sep 24, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-11782 NC
Physician Assistant 363A00000X 4133 SC Primary

Addresses

Primary practice location

1064 Gardner Rd Ste 105-106
Charleston, SC 29407-5768

Mailing address

1315 Ashley River Rd
Charleston, SC 29407-5315

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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

Enrollment IDStateProvider typePAC IDDetails
I20220404002456 SC Practitioner - Physician Assistant 8325434137 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Liberty Doctors LLCGroup PAC ID 0840466017, 44 clinicians

Practice addresses (Care Compare)

1315 Ashley River Rd
Charleston, SC 29407-5315
Phone (854) 429-1175

418 Folly Rd
Ab
Charleston, SC 29412-2625
Phone (843) 225-8320

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-11782NCMDPhysician Assistant
4133SCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Liberty Doctors LLC CurrentSince Jan 13, 2022 Accepting new patients
Liberty Doctors, LLC CurrentSince Jan 13, 2022 Accepting new patients
Liberty Doctors LLC Past Accepting new patients

Locations

1064 Gardner Rd
Ste 105
Charleston, SC 29407
Phone (843) 226-0046

1064 Gardner Rd
Ste 105106
Charleston, SC 29407
Phone (843) 491-9955

1315 Ashley River Rd
Charleston, SC 29407
Phone (843) 491-9955

418 Folly Rd
#A
Charleston, SC 29412
Phone (843) 225-8320

Interoperability endpoints

  • Direct secure messaging: lthomas@libertydoctors.ssdirect.aprima.com

Organizations & group practices 3

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1632441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753142400000",
    "number": "1689345076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 ASHLEY RIVER RD",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294075315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1064 GARDNER RD STE 105-106",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294075768",
            "telephone_number": "854-429-1175",
            "fax_number": "843-695-9467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "LACHELSIE",
        "middle_name": "NICOLE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-24",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-11782",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "4133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.