Provider Demographics
NPI:1649431420
Name:THOMAS, JASON (RNFA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 SOUTHRIDGE DR
Mailing Address - Street 2:STE 202
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-5677
Mailing Address - Country:US
Mailing Address - Phone:573-635-0401
Mailing Address - Fax:573-635-6715
Practice Address - Street 1:1616 SOUTHRIDGE DR
Practice Address - Street 2:STE 202
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5677
Practice Address - Country:US
Practice Address - Phone:573-635-0401
Practice Address - Fax:573-635-6715
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004003193163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO062603OtherCNOR CERTIFICATE FOR PROFESSIONAL ACHIEVEMENT IN PERIOPERATIVE NURSING PRACTICE
MOCEP11471OtherNIFA RN FIRST ASSISTANT PROGRAM COMPLETION CERTIFICATE