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General NPI Number Information
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NPI Number | 1255929535
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Entity Type | Individual
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Provider Name | JENNIFER LYNN THAYER FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | 1711 27TH ST BRAUNLIN BLDG, SUITE 306
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City | PORTSMOUTH
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State | OH
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Zip | 45662
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Country | US
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Telephone | 740-353-8661
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Fax |
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Provider Business Mailing Address
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Address Line | 2502 MCDOWELLS CREEK RD
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City | GARRISON
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State | KY
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Zip | 41141-8127
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Country | US
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Telephone | 740-357-4078
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0028116
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License Number State | OH
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