Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4914 POTOMAC HIGHLANDS TRL
GREEN BANK WV
24944-8507
US

IV. Provider business mailing address

PO BOX 134
GREEN BANK WV
24944-0134
US

V. Phone/Fax

Practice location:
  • Phone: 681-206-0668
  • Fax: 740-619-7029
Mailing address:
  • Phone: 681-206-0668
  • Fax: 740-619-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number43108
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11090
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: