Provider Demographics
NPI:1487995528
Name:THOMAS, JARED LEE (FNP)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11306 BRIDGEPORT WAY SW
Mailing Address - Street 2:STE D
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3037
Mailing Address - Country:US
Mailing Address - Phone:541-494-1111
Mailing Address - Fax:541-494-1099
Practice Address - Street 1:2925 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8179
Practice Address - Country:US
Practice Address - Phone:541-773-1435
Practice Address - Fax:541-858-6828
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61287895363L00000X
OR201350038NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner