Provider Demographics
NPI:1255929535
Name:THAYER, JENNIFER LYNN (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:THAYER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 MCDOWELLS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:KY
Mailing Address - Zip Code:41141-8127
Mailing Address - Country:US
Mailing Address - Phone:740-357-4078
Mailing Address - Fax:
Practice Address - Street 1:1711 27TH ST BRAUNLIN BLDG, SUITE 306
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662
Practice Address - Country:US
Practice Address - Phone:740-353-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0028116208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery