Provider Demographics
NPI:1811122526
Name:THOMAS, JENILEA K (PNP)
Entity type:Individual
Prefix:
First Name:JENILEA
Middle Name:K
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:JENILEA
Other - Middle Name:KAY
Other - Last Name:HUEFTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:190 E BANNOCK ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6241
Practice Address - Country:US
Practice Address - Phone:208-381-2088
Practice Address - Fax:208-381-2893
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX767112363LP0200X
ID77528363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics