Provider Demographics
NPI:1023720745
Name:THOMAS, JESSICA REN'EE (RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:REN'EE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9875 WILLOW BEND RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:WV
Mailing Address - Zip Code:24983-9739
Mailing Address - Country:US
Mailing Address - Phone:304-772-3094
Mailing Address - Fax:304-772-5020
Practice Address - Street 1:9875 WILLOW BEND RD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:WV
Practice Address - Zip Code:24983-9739
Practice Address - Country:US
Practice Address - Phone:304-772-3094
Practice Address - Fax:304-772-5020
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV103128163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool