Healthcare Provider Details

I. General information

NPI: 1902203870
Provider Name (Legal Business Name): JODIE THOMASON MSN, RN, PCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JODIE LANTZ

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR D3.01
DALLAS TX
75235-7701
US

IV. Provider business mailing address

1935 MEDICAL DISTRICT DR D3.01
DALLAS TX
75235-7701
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-7000
  • Fax:
Mailing address:
  • Phone: 214-456-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License NumberAP126788
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP126788
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: