Provider Demographics
NPI:1598912628
Name:SEELEY, THOMAS JASON (RN, CNP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JASON
Last Name:SEELEY
Suffix:
Gender:M
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-9757
Mailing Address - Country:US
Mailing Address - Phone:740-289-2371
Mailing Address - Fax:740-289-4291
Practice Address - Street 1:227 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-9135
Practice Address - Country:US
Practice Address - Phone:740-947-7726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.267227-COA1363LF0000X
OHCOA.10182-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2912727Medicaid
OHSE2031061Medicare PIN