Provider Demographics
NPI:1467725093
Name:THOMAS, JACKIE HAYES (NNP-BC)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:HAYES
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEADOWS TOWN RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:NC
Mailing Address - Zip Code:28753-9024
Mailing Address - Country:US
Mailing Address - Phone:828-273-4954
Mailing Address - Fax:
Practice Address - Street 1:509 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4601
Practice Address - Country:US
Practice Address - Phone:828-213-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC117303363LN0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal