Individual
JESSICA MARIE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1601 GREENE ST, COLUMBIA, SC 29208-4001
(803) 777-7412
Mailing address
1601 GREENE ST, COLUMBIA, SC 29208-4001
(803) 777-7412
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
0024181007
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/12/2020
Last updated
03/16/2022
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