Provider Demographics
NPI:1306418942
Name:THOMAS, JESSINA
Entity Type:Individual
Prefix:
First Name:JESSINA
Middle Name:
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 1:9191 W FLORISSANT AVE STE 200B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-1413
Mailing Address - Country:US
Mailing Address - Phone:314-326-0552
Mailing Address - Fax:
Practice Address - Street 1:9191 W FLORISSANT AVE STE 200B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-1413
Practice Address - Country:US
Practice Address - Phone:314-326-0552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health