Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant |
NPI | 1215402722 |
---|---|
Provider Name | Mrs. Jessica Myers Thomas |
First Address | Kenansville, NC 28349-8657 |
Second Address | Kenansville, NC 28349-8657 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2018 |
Last Update Date | 11/10/2018 |