MEDICARE: KISHORE J. THAMPY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME105361	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659367951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KISHORE J. THAMPY M.D.

Provider Business Mailing Address
First Line	:	4446 HENDRICKS AVE STE 134
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-6369
Country	:	US
Telephone Number	:	904-315-2242
Fax Number	:	904-212-0424

Provider Business Practice Location Address
First Line	:	3599 UNIVERSITY BLVD S STE 1200
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4288
Country	:	US
Telephone Number	:	833-443-8700
Fax Number	:	904-642-9108

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	06/04/2025

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