Provider Demographics
NPI:1346355450
Name:THOMAS, JENNIFER ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MEDICAL CENTER DRIVE
Mailing Address - Street 2:STE 307
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003
Mailing Address - Country:US
Mailing Address - Phone:270-441-4700
Mailing Address - Fax:270-441-4707
Practice Address - Street 1:225 MEDICAL CENTER DR
Practice Address - Street 2:STE 307
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7914
Practice Address - Country:US
Practice Address - Phone:270-441-4700
Practice Address - Fax:270-441-4707
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTR42751363L00000X
KY3005114364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
3928OtherMEDICARE GROUP
KY0392813OtherGROUP PTAN
KY3928OtherMEDICARE GROUP
3928OtherMEDICARE GROUP