Provider Demographics
NPI:1699114165
Name:THOMAS, JENNIFER (DVM)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2645
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74076-2645
Mailing Address - Country:US
Mailing Address - Phone:617-968-3163
Mailing Address - Fax:
Practice Address - Street 1:2021 CEDAR CT
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-8256
Practice Address - Country:US
Practice Address - Phone:617-968-3163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5551174M00000X, 174MM1900X
MA7201174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian
No174MM1900XOther Service ProvidersVeterinarianMedical Research
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK44822OtherOKLAHOMA STATE BUREAU OF NARCOTICS AND DANGEROUS DRUG CONTROL
OK5551OtherOKLAHOMA STATE BOARD OF VETERINARY MEDICAL EXAMINERS
MA7201OtherMASSACHUSETTS DIVISION OF PROFESSIONAL LICENSURE, BOARD OF VETERINARY MEDICINE