Basic Information
| Provider Information | |||||||||
| NPI: | 1700892924 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | MSNFNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 393 WALLACE RD STE 403 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372118003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152236200 | ||||||||
| FaxNumber: | 6152236100 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 WESTWOOD PL STE 110 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370277554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152062462 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 05/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN0000093854 | TN | N | Nursing Service Providers | Registered Nurse | 261QR1100X | N | Ambulatory Health Care Facilities | Clinic/Center | Research | 363L00000X | APN0000006736 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1518270115 | 01 | TN | GROUP NPI NUMBER | OTHER | 3499953 | 05 | TN | MEDICAID |