Basic Information
| Provider Information | |||||||||
| NPI: | 1851552673 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 212 ASHVILLE AVE | ||||||||
| Address2: | SUITE10 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275186669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198591136 | ||||||||
| FaxNumber: | 9198594240 | ||||||||
| Practice Location | |||||||||
| Address1: | 212 ASHVILLE AVE | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275186669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198591136 | ||||||||
| FaxNumber: | 9198594240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2008 | ||||||||
| LastUpdateDate: | 09/07/2012 | ||||||||
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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 | 207Q00000X | A103819 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2011-00755 | 01 | NC | NC MEDICAL BOARD | OTHER | A103819 | 01 | CA | STATE MEDICAL LICENSE | OTHER |