Healthcare Provider Details

I. General information

NPI: 1316711377
Provider Name (Legal Business Name): JODI THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 02/20/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 SCOTTSVILLE RD
BOWLING GREEN KY
42104-6800
US

IV. Provider business mailing address

PO BOX 90007
BOWLING GREEN KY
42102-9007
US

V. Phone/Fax

Practice location:
  • Phone: 270-282-7088
  • Fax: 270-782-6438
Mailing address:
  • Phone: 270-781-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3386
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: