Provider Demographics
NPI:1922566959
Name:THOMAS, JAISON (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JAISON
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 E 9TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5796
Mailing Address - Country:US
Mailing Address - Phone:405-896-6777
Mailing Address - Fax:
Practice Address - Street 1:1218 E 9TH ST STE 1
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5796
Practice Address - Country:US
Practice Address - Phone:405-896-6777
Practice Address - Fax:405-212-4057
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKF01191802363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty