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General NPI Number Information
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NPI Number | 1740728104
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Entity Type | Individual
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Provider Name | JENNA THOMAS
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Gender | Female
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 09/20/2023
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Provider Practice Location Address
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Address Line | 440 W LAUREL AVE
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City | PLENTYWOOD
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State | MT
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Zip | 59254-1526
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Country | US
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Telephone | 406-765-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 N COLLEGE AVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-1944
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Country | US
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Telephone | 794-443-4301
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 121966
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A134018
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License Number State | IA
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