1942299599 NPI number — PEPE L THOMPSON ACNP

Table of content: PEPE L THOMPSON ACNP (NPI 1942299599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942299599 NPI number — PEPE L THOMPSON ACNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
PEPE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ACNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942299599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 N OAK AVE
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
COOKEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38501-2435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-783-5857
Provider Business Mailing Address Fax Number:
931-526-6760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 W 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
COOKEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38501-2447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-783-2143
Provider Business Practice Location Address Fax Number:
931-783-2152
Provider Enumeration Date:
10/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  8346 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: 3013387 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: 8346 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3990989 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4271773 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7100448910 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3900988 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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