Provider Demographics
NPI:1831673755
Name:THOMAS, JENA M (APRN)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1294 BELLA ROSA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-6168
Mailing Address - Country:US
Mailing Address - Phone:435-862-6689
Mailing Address - Fax:
Practice Address - Street 1:652 S MEDICAL CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7077
Practice Address - Country:US
Practice Address - Phone:435-656-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7302843-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner