Provider Demographics
NPI:1265005201
Name:THOMAS, JENEQUA ANNETTE
Entity Type:Individual
Prefix:
First Name:JENEQUA
Middle Name:ANNETTE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6810 JEFFERSON HWY APT 8102
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8186
Mailing Address - Country:US
Mailing Address - Phone:504-460-5298
Mailing Address - Fax:
Practice Address - Street 1:6810 JEFFERSON HWY APT 8102
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8186
Practice Address - Country:US
Practice Address - Phone:504-460-5298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)