Healthcare Provider Details

I. General information

NPI: 1881920387
Provider Name (Legal Business Name): JERI SUE THOMAS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27799 STATE ROUTE 7
CHESHIRE OH
45620-9603
US

IV. Provider business mailing address

27799 STATE ROUTE 7
CHESHIRE OH
45620-9603
US

V. Phone/Fax

Practice location:
  • Phone: 740-590-1181
  • Fax: 949-695-4271
Mailing address:
  • Phone: 740-590-1181
  • Fax: 949-695-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11090
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-100415
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number43108
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: