Healthcare Provider Details

I. General information

NPI: 1609472679
Provider Name (Legal Business Name): ASHLEY JENE' E THOMAS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY JENE' E THOMAS CRNP

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 09/29/2026
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 ALLENSWOOD RD
RANDALLSTOWN MD
21133-4604
US

IV. Provider business mailing address

8500 ALLENSWOOD RD
RANDALLSTOWN MD
21133-4604
US

V. Phone/Fax

Practice location:
  • Phone: 443-796-8515
  • Fax:
Mailing address:
  • Phone: 443-796-8515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR217978
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR217978
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: