Basic Information
| Provider Information | |||||||||
| NPI: | 1235745761 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | ELLEN | ||||||||
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| Credential: | RDN, LDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 593 TEAKWOOD DR | ||||||||
| Address2: | |||||||||
| City: | RACELAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411691171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068318357 | ||||||||
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| Practice Location | |||||||||
| Address1: | 432 16TH ST | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411017693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063240128 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2020 | ||||||||
| LastUpdateDate: | 09/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | KY-1062 | KY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.