Provider Demographics
NPI:1942803226
Name:THOMAS, JENNIFER LYNETTE (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNETTE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 SE PROFESSIONAL MALL BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5423
Mailing Address - Country:US
Mailing Address - Phone:509-332-7511
Mailing Address - Fax:
Practice Address - Street 1:1205 SE PROFESSIONAL MALL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5423
Practice Address - Country:US
Practice Address - Phone:509-332-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID65438363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health