Provider Demographics
NPI:1245366038
Name:THAYER, JANE J (DNP, ACNP)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:J
Last Name:THAYER
Suffix:
Gender:F
Credentials:DNP, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6025 WALNUT GROVE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2131
Mailing Address - Country:US
Mailing Address - Phone:901-226-2199
Mailing Address - Fax:901-226-2010
Practice Address - Street 1:6025 WALNUT GROVE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2131
Practice Address - Country:US
Practice Address - Phone:901-226-2199
Practice Address - Fax:901-226-2010
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN5529363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3347539Medicare UPIN
AR5W840Medicare UPIN
MS500001008Medicare UPIN