Provider Demographics
NPI:1669791927
Name:RICHARDSON-THOMAS, JENNIFER (CEO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RICHARDSON-THOMAS
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2787 HWY 77 S STE 6
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-2383
Mailing Address - Country:US
Mailing Address - Phone:901-481-5375
Mailing Address - Fax:
Practice Address - Street 1:2787 HWY 77 S STE 6
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-2383
Practice Address - Country:US
Practice Address - Phone:901-481-5375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2025-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2397731744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty