Provider Demographics
NPI:1891269031
Name:THOMAS, JODIE MICHELLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:MICHELLE
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 1:2413 RING RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-5924
Mailing Address - Country:US
Mailing Address - Phone:270-737-0077
Mailing Address - Fax:270-982-2237
Practice Address - Street 1:2413 RING RD STE 100
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-5924
Practice Address - Country:US
Practice Address - Phone:270-737-0077
Practice Address - Fax:270-982-2237
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYF01190927363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner