Basic Information
| Provider Information | |||||||||
| NPI: | 1487096780 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | KEVIN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ARNP, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1940 HARRISON AVE | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324054542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8507630017 | ||||||||
| FaxNumber: | 8505326454 | ||||||||
| Practice Location | |||||||||
| Address1: | 1940 HARRISON AVE | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324054542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8507630017 | ||||||||
| FaxNumber: | 8505326454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2013 | ||||||||
| LastUpdateDate: | 03/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | RN124311 | GA | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 163WR0400X | RN124311 | GA | N | Nursing Service Providers | Registered Nurse | Rehabilitation | 163W00000X | RN124311 | GA | N | Nursing Service Providers | Registered Nurse | 163WA0400X | RN124311 | GA | N | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) | 163WG0000X | RN124311 | GA | N | Nursing Service Providers | Registered Nurse | General Practice | 163WH0200X | RN124311 | GA | N | Nursing Service Providers | Registered Nurse | Home Health | 163WW0000X | RN124311 | GA | N | Nursing Service Providers | Registered Nurse | Wound Care | 363LP0808X | ARNP9444970 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.