Basic Information
| Provider Information | |||||||||
| NPI: | 1811388739 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | JAYE | ||||||||
| MiddleName: | RACHELLE | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1901 | ||||||||
| Address2: | |||||||||
| City: | STUTTGART | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721601901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706746489 | ||||||||
| FaxNumber: | 8706726823 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 N NEW YORK AVE | ||||||||
| Address2: | |||||||||
| City: | BRINKLEY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720212722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707344405 | ||||||||
| FaxNumber: | 8707343438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2015 | ||||||||
| LastUpdateDate: | 02/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | A004323 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 201479729 | 05 | AR | MEDICAID | 201477729 | 05 | AR | MEDICAID | 201481729 | 05 | AR | MEDICAID | 203673729 | 05 | AR | MEDICAID | 201478729 | 05 | AR | MEDICAID | 201482729 | 05 | AR | MEDICAID |