Healthcare Provider Details

I. General information

NPI: 1699114165
Provider Name (Legal Business Name): JENNIFER THOMAS DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 CEDAR CT
STILLWATER OK
74075-8256
US

IV. Provider business mailing address

PO BOX 2645
STILLWATER OK
74076-2645
US

V. Phone/Fax

Practice location:
  • Phone: 617-968-3163
  • Fax:
Mailing address:
  • Phone: 617-968-3163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number5551
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number7201
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code174MM1900X
TaxonomyMedical Research Veterinarian
License Number5551
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: