1831681345 NPI number — MRS. KIMBERLY JEAN THOMPSON NURSE PRACTITIONER-

Table of content: MRS. KIMBERLY JEAN THOMPSON NURSE PRACTITIONER- (NPI 1831681345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831681345 NPI number — MRS. KIMBERLY JEAN THOMPSON NURSE PRACTITIONER-

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
KIMBERLY
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER-
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:
1831681345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
522 PATRICK FARMS DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARL
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39208-9424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-955-4269
Provider Business Mailing Address Fax Number:
901-227-8591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 KATHERINE DRIVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FLOWOOD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39232-9588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-665-4162
Provider Business Practice Location Address Fax Number:
855-830-3484
Provider Enumeration Date:
05/31/2018

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: 363LF0000X , with the licence number:  902648 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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