Provider Demographics
NPI:1851865802
Name:THOMAS, JEANETTE SUE (FNP)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:SUE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3330 NW 56TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4426
Mailing Address - Country:US
Mailing Address - Phone:405-563-8961
Mailing Address - Fax:888-521-6702
Practice Address - Street 1:3330 NW 56TH ST STE 106
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4426
Practice Address - Country:US
Practice Address - Phone:405-563-8961
Practice Address - Fax:888-521-6702
Is Sole Proprietor?:No
Enumeration Date:2019-01-13
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK50731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily