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Individual
MRS. JESSY THOMAS
Active
Individual
MRS. JESSY THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
334729
NY
363LP2300X
Primary Care Nurse Practitioner
Primary
209008189
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041380904
—
IL
01
—
920540
MEDICARE PTAN (GROUP)
IL
Enumeration date
07/10/2008
Last updated
04/10/2014
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