Healthcare Provider Details

I. General information

NPI: 1174427397
Provider Name (Legal Business Name): JAWANDA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 COURSEY BLVD APT 1042
BATON ROUGE LA
70816-4530
US

IV. Provider business mailing address

12625 COURSEY BLVD APT 1042
BATON ROUGE LA
70816-4530
US

V. Phone/Fax

Practice location:
  • Phone: 225-733-2003
  • Fax:
Mailing address:
  • Phone: 225-733-2003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: