1396772554 NPI number — MISS JAMERA A THOMPSON PA-C

Table of content: MISS JAMERA A THOMPSON PA-C (NPI 1396772554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396772554 NPI number — MISS JAMERA A THOMPSON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
JAMERA
Provider Middle Name:
A
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1396772554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7505 SANDIFUR PKWY STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASCO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99301-8062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-411-5469
Provider Business Mailing Address Fax Number:
855-459-3020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7505 SANDIFUR PKWY STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASCO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99301-8062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-411-5469
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/26/2006

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: 363A00000X , with the licence number:  PA10003356 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0218968 . This is a "LIWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 163677 . This is a "LIWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1396772554 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8321291 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8763TH . This is a "BSWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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