1811388739 NPI number — JAYE RACHELLE THOMPSON APRN

Table of content: MADELEINE MORALES-STANLEY (NPI 1760810360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811388739 NPI number — JAYE RACHELLE THOMPSON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
JAYE
Provider Middle Name:
RACHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
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:
1811388739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 497
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72006-0497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-347-2534
Provider Business Mailing Address Fax Number:
870-301-2092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRINKLEY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72021-2507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-734-1150
Provider Business Practice Location Address Fax Number:
870-734-1179
Provider Enumeration Date:
02/13/2015

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:  A004323 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201481729 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201478729 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201479729 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201477729 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201482729 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 203673729 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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