Provider Demographics
NPI:1215402722
Name:THOMAS, JESSICA MYERS (CLC, LCCE, CD (DONA))
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MYERS
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CLC, LCCE, CD (DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 SARECTA RD
Mailing Address - Street 2:
Mailing Address - City:KENANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28349-8657
Mailing Address - Country:US
Mailing Address - Phone:910-340-4771
Mailing Address - Fax:
Practice Address - Street 1:679 SARECTA RD
Practice Address - Street 2:
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349-8657
Practice Address - Country:US
Practice Address - Phone:910-340-4771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula